Whether you are getting Pennsylvania workers’ compensation or whether you are fighting with the insurance company to get workers’ compensation for your work injury, you will get a letter from some stranger mentioning that they have some relationship with your worker’s compensation carrier and that they want you to see a doctor for an “independent examination”. Keep in mind that this event is neither “independent” nor an “examination” within the traditional meaning of either of those words.
Under the Pennsylvania Workers’ Compensation Act, the employer/insurance company is entitled to have you examined by a doctor of their choosing every six months at a “reasonable time and place”. This “rule” is one based on general practice and custom and can be limited by a Judge upon the filing of a petition by your attorney. Such limits may be “the mere passage of time” and any attempt by the insurance company to attempt to re-litigate a previously settled issue. If proven the Judge is satisfied that the insurance company has no basis for another exam, he or she MAY rule that an additional exam is not necessary. Likewise, the Judge can deny the exam because the distance from your home is not reasonable. If you fail to attend the exam after a Judge’s order without a reasonable excuse, your benefits can be suspended after the filing of a Suspension Petition by the insurance company, until such time as you attend the exam.
Under this provision, you can be asked for or the insurance company may obtain, any and all medical records which are not otherwise privileged, i.e. drug and alcohol rehabilitation records, HIV information and mental health records, unless you are pleading a mental illness as part of your claim. This would include any records of your family doctor, any hospital visits, testing and current treating doctor reports. Generally, the insurance company will want records for the past 3-5 years. Also, if the insurance company searches your name by injury or social security number (also known as an “index search”) and finds a similar injury or name with a past motor vehicle or workers’ compensation claim, they may also ask for the legal pleadings relative to those actions.
As to the exam itself, it has often been said that it takes less time than the preparation of a three minute egg. Usually, the exam occurs with a doctor paid for by the insurance company. He or she is not your friend. The majority of time is spent with the taking of your medical history with 3 minutes on the exam. The history portion is often completed by the doctor but also frequently performed by a member of the staff. We recommend the timing of the exam with written notes as to the tests performed, the questions asked, and answers provided. You may want to bring a friend or have a nurse accompany you to the exam. It is a violation of federal wiretapping laws to tape record without the knowledge of the examiner. DON’T DO IT! Finally, you should also be aware that the insurance company can place you under surveillance and provide that to the doctor for his review.
