Law Offices of Brian P Rourke

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Occasionally, the insurance company will ask you to attend a doctor’s appointment with a physician they have hired. These doctors review your medical file, and perform an examination of you at their office. These exams are generally scheduled every few months, if you are collecting weekly checks. Their doctor will give an opinion in a written report describing your injuries and your degree of disability. Frequently their opinion differs from your own doctor, and the company will ask for a hearing to try to reduce your benefits. When you get the report (in about ten days), immediately make an appointment with your own doctor, and have him or her review and comment upon the IME’s findings. This will help us defend your case. An IME may also be scheduled if your doctor gives a permanency opinion, there is a request for surgery, or a request for a medical treatment. The important thing to know is that the insurance company has the right to have you seen, and failure to keep the appointment will delay your benefits. If you can’t make it, immediately call the company to reschedule the date. Remember that, while their doctor is hired by the company, he is not necessarily the enemy.

Mr. Rourke is the managing partner and a founding member of the Law Offices of Brian P. Rourke, PC. He is a graduate of Binghamton University (BS, 1986) and Pace University School of Law (JD, 1998), where he graduated Cum Laude. Prior to entering private practice in Liberty, NY, he served as corporate counsel to a Fortune 500 insurance company and then worked for Cozen & O’Connor, LLP, a global law firm specializing in insurance litigation. At Cozen, he worked on several high-profile insurance coverage cases.

New York State has passed laws about committing insurance fraud in workers compensation cases. They are extremely serious about this, and the penalties can include making you repay your benefits, losing any future benefits and even jail time. An issue of fraud is raised by the insurance company if they think you might be lying to them about the cause or extent of your injuries, or if you are claiming to be out of work yet making money on the side or under the table. You may be committing fraud if your doctor tells you not to do any heavy work, yet you are putting on a new roof on your house. Or if you are not supposed to walk for long distances, yet come in third at a marathon. These are silly examples, but it gives you an idea of what constitutes fraud. We see many cases where the insurance company has hired a private investigator and videotaped a person doing something their doctor says they should not do. They immediately assume that you have exaggerated the seriousness of your injury and push for your benefits to stop.

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