How Do I Get My Medical Bills Covered After IME or DME Cuttoff?

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How Do I Get My Medical Bills Covered After IME or DME Cuttoff?

In today’s video, Attorney Ben Schwartz answers the question, “How do I get my medical bills covered after an IME or DME cutoff in a personal injury or workers’ compensation case?”

Hi, I’m Attorney Ben Schwartz,

Today we are continuing our series on IME’s and DME’s after personal injury cases. If you watched the previous videos in the series you will know that an IME stands for an independent medical exam and DME stands for defense medical exam. Essentially what we are talking about are exams with doctors bought and paid for by the insurance company in order to give either an independent or a defense opinion on the nature and extent of injuries. The doctor will determine if medical treatment continues to be necessary, on whether lost wage reimbursement continues to be necessary after a personal injury case, after a car accident case, slip and fall case or after a work-related injury.

Today we are going to continue with the questions in the series. Today’s question is, “How do I get medical bills covered after an IME or DME cut off in Delaware?” I am going to describe the process generally for Delaware cases, there are similar proceedings in other states. If you have had an IME or DME cut off in another state other than Delaware, understand that I am using the Delaware procedures as an example, but you need to have an attorney who is licensed to practice in the state where your IME or DME cut off occurred to assist you in getting your medical bills paid.

So, “how do I get my medical bills covered after an IME or DME cut off in Delaware?” The answer is, it depends on whether we are talking about a car accident case or a workers’ compensation case. In a car accident case, let’s say we have a motorist who is injured in an auto accident. Their auto insurance under personal injury protection or PIP is going to be required to pay their medical expenses after the car accident to a doctor (friendly doctor, friendly to the insurance company.) The doctor will examine the person and give a letter to the insurance company that says this individual requires no further medical care or treatment. At that point, the car insurance company will refuse to voluntarily pay any further medical bills.

It also comes up in the situation of work-related accidents where an individual is injured on the job. They are going to the doctor, the doctors treating them, halfway through the regiment of treatment, the workers’ compensation insurance company for the employer paying the medical bills, they will decide to send that injured worker to a defense medical examiner. The defense medical examiner will examine the worker and give an opinion saying this person needs no further treatment as a result of the work injury. At that point, the workers’ compensation insurance company will refuse to voluntarily pay any further benefits.

The solution to this is if it is an auto accident case you take the medical bills that were not paid for and you file what’s called ICA (Insurance Commissioner’s Arbitration.) You file a complaint with the Insurance Commissioner’s Office on Silver Lake Boulevard in Dover, Delaware. You request an arbitration hearing. You will get an opportunity to go in and present your case to a panel of three arbitrators and they will make a decision as to whether the additional medical treatment was needed due to the auto accident or not. If they decide that it was, and often times they do, they will order the insurance company to pay the medical cost of the medical treatment. Another option is to file a lawsuit either in Delaware Court of Common Pleas or in Delaware Superior Court.

If it is an on-the-job injury then you do not go through the Insurance Commissioner’s Office. You do not go through a court of law either. If you have a work-related injury, workers’ compensation started paying then cut off the medical care after a DME, you file a petition with the Industrial Accident Board. You will go to a hearing before the Industrial Accident Board, which is called a petition to determine additional compensation due (DACD) petition. You go to a hearing and ask the panel of Industrial Accident Board Members to award compensation in the amount of the unpaid medical bills. Of course in both of these types of cases, you need to have physician testimony. The doctor who treated you should be prepared to give testimony to say that the care rendered after the cut off of the IME or DME was reasonable and necessary as a result of the auto accident, on-the-job injury, or what have you and that is how you prove that case.

If you have had a personal injury, auto accident, or on-the-job injury and you have had an IME or DME cut off that is a good indication that you should be getting your case into the hands of a capable personal injury attorney. A capable personal injury attorney is going to know how to deal with that cut-off, how to get you the medical treatment that you need, despite what the insurance companies paid doctor might be saying about the need for further care or further surgery. A skilled personal injury attorney knows the process and has been through the process many times and can make sure that you get the care you need and make sure that your bills get paid.

If you have questions about personal injury cases and the IME/DME process feels free to contact me, you can email me below. If you have an insightful question about the IME or DME process maybe we will do a follow-up video to answer your question. If you have questions about personal injury cases in general feel free to contact me. My hope is that I can put out this information for people in the community who can watch this video and learn more about the process. I want to increase awareness about the process, even if you, not my client, you can watch these videos and understand what is going on. These are things that happen a lot of times in personal injury cases and it is very frequent. If you are not someone who has had an accident and you are watching the video maybe you are just interested in the law, or interested in the legal process, or interested in how things work, that’s cool. I want people to know about how things work because knowledge is power and if you have this type of situation happen you deserve not to be afraid. You deserve not to have anxiety over the process because that is what it is, it is a process and we know how to deal with it.

Thanks for watching! I appreciate you. Send me an e-mail below and let me know your thoughts.

Please be sure to watch our previous videos in this series:
Why Do Insurance Companies Request a Medical Exam?
What is the difference between an IME and a DME In Personal Injury Cases?
What can I do if the doctor lied in my Defense Medical Exam?

 

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