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Understanding the ‘tiebreaker exam’ process

| Dec 14, 2020 | Workers' Compensation

You’re receiving workers’ compensation benefits because your employer’s workers’ compensation insurer has admitted liability for your workplace-related injury. Now the doctor who’s been treating you says that you don’t need further treatment and/or that you’re well enough to return to work. You’re examined by another doctor who disagrees. The disagreement may be over the type of treatment needed. That’s where a tiebreaker exam comes in.

What are your responsibilities in a tiebreaker exam?

Any number of people involved in the case can make a request to the Worker’s Compensation Division (WCD) of Wisconsin’s Department of Workforce Development (DWD) for the exam by yet another physician, including the employee, the employer, the insurer, an attorney or a doctor. However, the insurer and/or employer are responsible for the cost of the exam. (The employee is responsible for travel expenses if the tiebreaker doctor isn’t nearby.)

It’s important to provide the tiebreaking doctor with the relevant information they need on the employee’s condition, treatment and job. However, communication with the doctor is restricted. It’s essential to understand those restrictions as well as your responsibility in scheduling and appearing for the exam.

What can happen after the exam?

The tiebreaking doctor may request additional testing or go ahead and issue their report to the WCD after the exam. Depending on the tiebreaker doctor’s findings, an employee may get retroactive benefits if it’s determined that their benefits were wrongly suspended.

If, based on the doctor’s findings, it’s determined that the employee was paid benefits they shouldn’t have been, they can’t be ordered by the state to repay the money. However, the insurer could potentially start collection actions or even take the person to court.

The whole workers’ comp process can be a confusing, daunting one – particularly when there are disagreements regarding the cause, extent or treatment of an injury or illness. Disagreements over when and if an employee can return to work – and in what capacity – are not uncommon. That’s why it’s wise to have an experienced workers’ comp attorney by your side to guide you through the process and help you explore all of your options for fair compensation.