What Is an Independent Medical Examination?
When an employee sustains an injury on the clock, that individual could file a workers’ compensation claim if the company has insurance. Depending on the insurance carrier, the worker may have to undergo an independent medical examination. The insurance company selects the physician to perform this examination to determine whether to accept the injury claim.
Why Is an Independent Medical Examination Necessary?
Not every workers’ comp case requires an independent medical examination. After reporting an injury, an employee may have a choice of doctors who are part of the insurance provider’s network. The worker chooses which physician to see to determine medical treatment, if the injury could become a permanent disability, and when the person can go back to work.
Occasionally, insurance companies take issue with a medical professional’s diagnosis or the recommended medical treatment. If they do, they choose another doctor for the employee to see for an IME. Sometimes, a case hearing officer or judge may be the one to request an IME.
What Are the Rules Surrounding Independent Medical Examinations?
Insurance companies that request IMEs also select the physician to conduct them. While this doctor should be neutral, that is not always the case. Insurance providers pay physicians for their professional opinion. Some doctors side with the insurance company to continue making money from medical reports. After going against the insurance company, a doctor may not receive another request to perform an examination. It is not unheard of for coverage providers to shop around for healthcare professionals likely to side with them rather than who are genuinely neutral. Injured employees may want to work with a workers’ comp legal professional for their claim.
Depending on the state, workers may request an IME if they do not agree with the workers’ comp physician’s opinion. In this case, the employee chooses the doctor to perform the examination.
Some states choose the examining physician randomly from a list of experienced specialists. Sometimes, the judge decides the examiner.
What Happens During an Independent Medical Examination?
Before the actual examination, the selected physician receives copies of the injured employee’s medical records, injury report, and all other documents related to the injury. The doctor can look over the documents either before or after the evaluation. Additionally, the insurance provider may send the doctor a letter that breaks down the worker’s injuries, current course of treatment, and questions for the doctor.
Patients have the right to ask to see any letter a workers’ comp provider sends the physician. This ensures that the questions are appropriate and that the letter does not contain factual errors.
Injured individuals must understand that they do not have doctor-patient confidentiality with the person conducting the IME. Anything they say during the meeting could be turned against them during a workers’ comp hearing. Doctors may also observe patients from the moment they step out of their car to walk to the medical office until they walk back at the end of the examination. Any inconsistencies, such as walking normally across the parking lot but limping into the office, could go into the doctor’s report and become evidence for the insurance company.
During the actual examination, physicians often ask how the injury happened, what kind of medical history the patient has, and what course of treatment the patient currently follows. The employee may undergo physical exams to test range of motion or strength.
How Can Employees Prepare for an Independent Medical Examination?
Before their IME, workers can:
- Look over their medical history
- Consider how they became injured and the specific body parts that sustained injury
- Review the specific situation and factors that led to the original incident
- Think about how their injury impacts day-to-day life and restricts their movements or lifestyle
- Consider how they would describe their pain or discomfort, such as sharp, dull, sudden, shooting, radiating
- Note all medications they take to treat the injury
- List activities they can still do and that do not cause them pain
While it is a great idea to write down the above information, employees should not bring their written answers with them to their examination. Doing so could give the examiner the impression that the answers to questions could be rehearsed. The main goal of pondering the above information is to help respond to common IME questions with descriptive, accurate answers.
What Does a Doctor Look for During an IME?
Doctors do more than look over health records and answer questions during medical evaluations. They also consider the patient’s general appearance, including what the person wears and even how the employee gets onto the examination table.
Physicians also keep their eyes peeled for indications of deception and exaggeration. It is not unheard of for insurance companies to comb through an injured employee’s social media feed for posts and images that belie their verbal and physical responses and workers’ comp claim statements. Sometimes, coverage providers hire private investigators to surveil patients.
What Happens After an IME?
At the end of the IME, the physician composes a detailed report, noting the insurance company’s concerns, such as if the employee can perform regular job duties. Depending on whether the coverage provider or worker wants to take legal action, a workers’ comp legal advocate may receive a copy of the report.
Usually, judges in these cases give substantial credence to IME doctors, sometimes more than they do to the original treating physician. Unfortunately, medical examiners are not always as impartial as they should be.
How Does an Unfavorable Independent Medical Examination Impact a Legal Case?
Employees can contest an evaluation’s findings if they feel the results are not accurate. They can send a letter to the insurance company about the false details and request clarification or an addendum. If there exists evidence to argue a point, the person should include it with the letter.
If the results of the examination limit one’s worker’s compensation benefits, a legal defendant can fight the results in court. The medical professional handling the evaluation may lack the proper credentials, a fact that may shift the case in the employee’s favor.
Work With an Experienced Local Lawyer
Is your employer fighting against your workers’ comp claim by requesting an IME? Submit a request online or call us today at (866) 345-6784 to get in touch with an experienced lawyer in your area!