If you’ve filed a workers’ compensation claim after a work-related personal injury takes place, then you’ve already seen at least one doctor who has diagnosed your condition, recommended treatments, and indicated how this injury or illness will impact your ability to return to work.
However, if the insurance company is disputing your workers’ compensation claim, you may have to undergo an independent medical examination, otherwise known as an IME.
What Is An Independent Medical Exam?
An independent medical examination (IME) is an examination ordered by an insurance carrier when you are in the process of applying for workers’ compensation benefits.
As mentioned above, by the time insurance companies request that you complete an IME, you’ve likely already been examined by a doctor you are familiar with. However, insurance companies will often request that you undergo an IME with a different doctor because the first diagnosis you received may have been perceived as excessive.
The “Second Opinion”
The insurance provider won’t admit that there are concerns with the cost of your medical treatment; instead, the independent medical exam will be touted as a method for obtaining a qualified “second opinion” from doctors in the field.
As you can imagine, insurance companies are unlikely to ask you to get an IME if your first medical evaluation found no conditions requiring medical treatment.
On the other hand, if the first doctor’s diagnosis determines that your injuries are severe and therefore require significant intervention and/or prolonged medical treatment, they are likely to request that you visit an IME doctor (selected by them) for additional study of your personal injury.
What Is The Purpose Of An IME?
The purpose of these medical examinations is to resolve any disputes about the medical condition claimed by an injured worker. Correspondingly, an independent medical exam (IME) is conducted by a physician who is supposed to be impartial.
In many cases, and to the detriment of the person filing the workers’ compensation claim, IMEs can go against an initial diagnosis.
If your first doctor insisted on you undergoing expensive surgery to treat a work-related medical condition, IME doctors may instead advise against surgery and opt for other treatment methods such as therapy before “going under the knife.” If an initial medical evaluation determined that you had a permanent disability, an IME may argue against this, instead suggesting that you can return to work if prescribed pain management medication.
Are IME Doctors Fair?
The outcome of an independent medical examination can severely impact workers’ compensation cases and should be taken quite seriously. Understanding this, individuals who have to visit an IME doctor for a medical evaluation often wonder whether the physician will be fair in their assessment.
Unfortunately, it’s impossible to say without looking at a particular IME doctor’s track record. Additionally, the rules regarding an IME doctor can vary drastically from state to state.
For instance, in Pennsylvania, the insurance company is generally allowed to choose the physician that will be performing the examination.
There are rules that need to be followed, however. According to the law when a mental and/or physical examination is made:
- The “examiner” must be a licensed medical physician, dentist, or psychologist.
- The patient has the right to have counsel or other representatives with them during the exam.
- The physician completing the IME must provide a detailed report (IME Report) about all findings, including test results, diagnosis, and recommendations.
Keep in mind that while most doctors are honest, the doctor working with the insurance company is usually selected because they have previously provided the outcome that the company is hoping for.
IME Doctors & The Doctor-Patient Relationship
When one visits a doctor for regular medical examinations, what is known as a doctor-patient relationship is established.
This means that any information you share with your doctor is confidential. Sharing personal details such as those found in your personal medical reports can be considered a HIPAA violation and is punishable by law.
Yet, during an IME, no doctor-patient relationship is established. Most prominently, this means that the examining doctor has no obligation to withhold information from the entity paying them for the IME; in this case, it is the insurance company who is footing the bill.
You should expect the extent of injuries or any disability to be shared with the insurance company in detail, whether it’s included in the final report or not.
What Happens During An IME?
Prior to completing a physical examination, the doctor who has been assigned will be provided with your medical records and any other relevant medical documents regarding your health. The insurance company may write a letter containing a summary of the treatments you’ve already undergone and they may include questions that the company would like answered.
It’s important to obtain a copy of any letters sent by the insurance company so corrections to the summary can be made, if necessary.
During the physical exam, the doctor will likely ask questions about the accident, how you became injured or ill, and about your symptoms. Remember that anything you tell this physician is NOT privileged information and could impact your case. However, be honest about what you are experiencing and don’t try to exaggerate any of your symptoms.
Once the physical exam is complete, the doctor may request that additional tests, such as blood tests, be performed.
Can I Prepare For My IME?
Yes, there are steps you can take to prepare for an IME. Consider the following:
- Review what the insurance company has told the physician. If there is anything that needs to be corrected or questions that are inappropriate, your attorney can address this.
- Review your own medical history. This might sound silly but it’s important to be able to answer any questions that the physician has about your past medical history. When undergoing a large number of tests, it can be easy to get confused about dates and results.
- Write down your symptoms. It’s easy to forget to mention something during this exam. By writing down your physical and emotional experiences, it gives you a reminder of the important things that should be mentioned.
- Pick out an appropriate outfit. No, we don’t mean you have to wear business attire. What we mean is don’t forget to bring the supports and devices with you that help you with your injury, like crutches, braces, or slings.
- Ask someone to join you. Bring your friend or relative to the exam with you. Have them witness the exam, take notes, and provide you with support.
Once the exam and any testing are complete, the physician will send an IME report to you and the insurance company.
The IME Report
Review this immediately with your attorney so that any mistakes can be corrected immediately.
Your attorney may also choose to get a second opinion on the findings included in the IME report. Your attorney, while familiar with the law surrounding an independent medical examination, is unlikely to be well-versed in medical conditions. Accordingly, at this time they may take your IME report to another doctor who can provide an unbiased take.
Ultimately, the IME report is what the insurance company will use to establish your condition, course of treatment, and amount of benefits to be covered. If you are unable to legally argue against any information found in the report in a concrete fashion, it could prove detrimental to your claim in the present moment as well as down the line.
What Should You Not Say In An IME?
Persons undergoing an independent medical examination are justified in being concerned about what they may admit to the IME doctor. Yet, there is no set of rules or guidelines with regards to what you should or shouldn’t withhold during an IME.
Lying to the IME doctor, exaggerating your condition, or otherwise being untruthful during the process can be construed as fraud. If an insurance carrier learns of such fraudulent behavior, they are likely to pursue legal action outside of your workers’ comp claim. This could result in hefty fines and perhaps even jail time, so it’s best not to even consider this avenue.
Nevertheless, there is a better way of carrying out an IME: it is with the help of a workers’ comp attorney. With a lawyer physically by your side during the exam, you can be sure that you will be protected from inadvertently hurting your chances of receiving maximum compensation.
Hiring A Workers’ Comp Attorney For Your IME
If you haven’t retained a lawyer and have been ordered to conduct an IME, now is a good time to consider seeking legal representation. Schuster Law is a team of experienced workers’ comp lawyers who have stood by the side of our clients throughout the entire claims process, including in independent medical examinations.
Call us today to schedule your free consultation. We’ll calmly explain the process and simplify the options at your disposal. If you decide to work with us, you’ll owe us nothing unless we’re able to get you compensation. Otherwise, our legal services will be free of cost.
You’ve got nothing to lose – call our team today and get the answers you need.
