If you’ve suffered from a work-related injury or illness in most cases, your primary physician will determine your care, when you can return to work, and whether you have any disabilities as a result of the incident and to what extent. In some workers’ compensation cases, your employer’s insurance company may disagree with your doctor’s recommendations or want a second opinion and request you undergo an independent medical exam, or IME.
The outcome of this exam can significantly impact your case and what you will receive in care and benefits, so it is important to understand how an IME works and what you can do once the results are in.
WHAT IS AN IME AND WHY MIGHT I NEED ONE?
An IME is a medical evaluation performed by another doctor who is to act as a neutral party between you and your employer and is often used to resolve any questions about your medical condition that the insurance company may have. Often, they are requested by your employer because they disagree with a decision made by your primary doctor about your treatment or results of care.
An IME is supposed to use an objective point of view to determine your treatment, whether you have a permanent impairment and to what degree, and your ability to work in the future. However, how objective your IME is may depend on how the doctor is selected.
The rules can vary from state to state, but often the insurance company can select the doctor who will perform the evaluation. In these cases, there is a good reason to question the impartiality of the doctor selected as the doctor will be paid by the insurance company and may rely on the company for referrals.
The examining doctor may also be randomly selected from a list of qualified specialists or assigned by a judge overseeing your case.
Regardless of how the doctor is chosen, we always recommend patients consult with a workers’ compensation attorney when asked to undergo an IME or when beginning a workers’ compensation case. Your attorney can be an advocate for your treatment during a hearing or rebut the IME and help you negotiate a favorable settlement of your case.
WHAT HAPPENS DURING AN IME?
Prior to the examination, your medical records and documents relevant to your condition such as the injury report or statements given in your case will be sent to the IME doctor. Your employer’s insurance company may also write to the doctor posing specific questions about your condition and your primary doctor’s recommended course of treatment. It is up to the doctor to review the information before or after the IME.
It is important to note that the IME doctor is not going to engage with you in the typical doctor-patient relationship and will not offer advice, medical treatment, or share his or her opinion of your case. Anything you say or do during the examination is not privileged or protected and could be used against you.
Your attorney may recommend bringing a friend to the IME to act as a witness in your defense. Your friend or family member can take notes on what time the doctor begins and ends the exam, what questions are asked, and what tests are done.
During the examination, the doctor will likely start by asking how the incident occurred, a discussion of your medical history, and the course of treatment so far. Several exams and tests may also be conducted to determine your condition.
Afterward, the doctor will write a report with his or her conclusions and opinions in response to your case and the disputed issues in question. Both parties will receive a copy of this report.
THE REPORT IS OUT. HOW DOES THE IME AFFECT MY CASE?
Your employer will follow the findings of the IME report. If the results are positive, then you can continue your primary doctor’s original course of treatment and necessary benefits.
It is not uncommon for the IME doctor to disagree with your primary physician. There can be various reasons for the disagreement in opinions. Your employer and the insurance company will rely on the IME report and may refuse to pay benefits, authorize additional treatment, or accommodate your work restrictions despite your need for more care. In this case, your attorney will have to counter the IME report which could take weeks or months before a trial or decision is made.
HOW TO CHALLENGE A NEGATIVE IME REPORT
The IME doctor may regularly work for your employer’s insurance company and may minimize the extent of your injuries in favor of the insurance company resulting in a negative report.
However, you can counter the report and have your attorney file objections or request another examination. There are several things you can do to counter the report, including:
- Ask for a complete copy of the report rather than just certain portions of it. This can help to determine if the examiner was unfair, brief, or taken without considering previous conditions.
- Point out any inaccuracies or incompleteness in the report. Use your own medical records or your witness’ notes to point out the contradictions.
- Contrast the amount of time your IME doctor spent diagnosing and treating you compared to your primary doctor.
- You can also request your doctor to write a response that counters the IME doctor’s report.
For more information on independent medical examinations and how we can help, please contact Paul M. Brisson, MD Orthopedic Spinal Surgeon today.