If you filed a disability claim under workers' compensation you may feel a little rattled. The process is very important for you as it may determine or be a factor in determining if your work-related injury or illness still qualifies you for continuing your workers' comp benefits.
What is an independent medical exam (IME)?
The IME is a process used by insurance carriers as a tool for evaluating your medical condition and resolving questions carriers may have that include needed treatments and the degree of disability you or your loved one suffers that causes impairment.
How do I choose the doctor to perform the IME?
In short, you don't. The insurance company chooses the physician, not you. Bear in mind that the IME process is supposed to be an impartial review - but just how independent depends on the selection process. Many doctors who do IMEs count on the referring insurance company for a number of additional referrals. But, when a doctor submits an IME, not in keeping with the carrier's idea that further treatment is unwarranted, the insurance carrier may be unlikely to continue sending the provider more cases in the future. So, insurance selected physicians are incentivized to lessen the magnitude of your work-related workers' comp injury or illness in order to pay less.
Is an IME different from an exam with my doctor?
An IME is supposed to be a comprehensive examination, but there are differences. For starters, any expectation of privacy you normally have with your personal physician does not apply to an IME as you waive that privilege when you filed your case.
Actions to take during an IME
The examining physician will receive your medical records and other documents concerning your injuries. These other documents may include your injury report and statements you gave about your case. One key document is a letter from your insurance company that informs the provider about your injury, a summary of your treatment to date and specific questions about your medical condition. These questions may include asking for an opinion on whether or not your injuries are consistent with a work-related accident or whether a course of treatment recommended by the doctor caring for you is justified.
When you are notified about the IME appointment, send them a letter requesting a copy of any correspondence between the insurance company and the doctor about your case. This way, if the insurance company makes any factual mistakes in their letter to the doctor, you can correct the errors. During the IME, the physician may question you about how the accident occurred, questions about your relevant medical history and the course of treatment you have received.
Are there any other issues or concerns with independent medical exams?
Indeed, there certainly can be depending on the examiner. Some IME examiners are semi-retired doctors who are not trained in assessing injuries and illnesses related to work environments. There are concerns that examines may be hurried, not thorough and generally, favor the insurance company.
Improper, incomplete or incorrect IMEs can lead to disaster for claimants. Results of IMEs can vary from insurers slashing benefits, withholding treatment of work-related injuries, or simply slow the process down for the claimant
If you suffered an injury resulting from a work-related accident and the insurance carrier IME examiner finds against you, contact an experienced workers' compensation injury to learn more about your legal options.