What to Expect From Workers’ Compensation Doctors (IMEs)—And What to Watch For

Doctor Appointment

As lawyers focusing on Workers’ Compensation claims, it’s heartbreaking to see how many workers are injured each year. Sadly, many of these individuals have trouble receiving the benefits or full amount of benefits they deserve because their employer’s Workers’ Compensation insurance company does everything they can to reduce or deny benefits. One strategy the insurance companies will use is an Independent Medical Examination (IME), a medical appointment with a doctor hand-picked by the insurance company or their attorneys to evaluate purportedly how severe the victim’s injuries really are.  

If you’re not completely prepared for the IME, you may accidentally say or do something that could be used against you.

What to Know Before You See a Doctor for Your Workers’ Compensation Claim

The insurance company will work hard to lower their spend, so they will look for every excuse to reduce or deny you benefits. Insurance companies pay close attention to your medical records when determining whether you have a claim. Here are some guidelines you should follow to improve your chances of receiving workers’ compensation benefits:

  1. Don’t delay medical treatment. If you’re involved in an accident at work but don’t feel any immediate pain, report it to the proper managers and seek a doctor’s opinion. The symptoms of an injury could take days or weeks to appear. 
  2. Keep all medical appointments and follow all treatment advice. If you skip an appointment or skip refilling a prescription, the insurance company will question the severity of your injury. They’ll use your inaction as evidence that you don’t need workers’ compensation benefits. 
  3. Stick to the facts in your medical appointments. Your doctors will ask you how you were injured. Report the basic facts if you need to, and don’t try to guess any of the details surrounding the incident. If you don’t know, say so. The insurance company will compare these details to the account you gave your employer or their doctor. If there are any inconsistencies, the insurance company will question your credibility. 
  4. Be honest about your medical history. Your doctor needs as much information as possible to properly treat you. If you injure the same arm your broke 10 years ago while playing football, let your doctor know about your past injury. Failure to do so will reduce your credibility.
  5. Tell your doctor about your pain and physical limitations. While you should always be honest, go into detail about the pain you’re experiencing and how the injury is limiting your physical mobility. Ensure the doctor records these notes in your medical file for the insurance company to see. If these details aren’t recorded, the insurance company and their doctor will have more reason to question how severe your injuries are. 
  6. Keep good records. You have a lot going on in a workers’ compensation claim: doctor appointments, physical therapy sessions, specialist appointments, and maybe even meetings with your lawyer. There’s a lot to keep track of. Keep good records by tracking each session related to your injury in a notebook and keep all paperwork in a folder. These details will help you if you have to face off against the insurance agency. 

Navigating the IME

The doctor in your IME has competing priorities. The doctor has sworn to the Hippocratic Oath, but they’re also receiving a steady stream of business from the insurance company. If they can’t help the insurance company reduce its claims, there’s a chance the insurance company will send the doctor fewer referrals.

To ensure the insurance company remains happy, these doctors will often recommend that you return to work before you’re 100%. They may try to minimize the extent of your injuries in your medical records. If your injuries appear smaller or less severe, the insurance company has a better chance of denying or reducing your benefits. 

Appointments with the IME are typically faster than your usual doctor appointment. They may review your medical history, ask you a few questions, examine you, then get you on your way. If you can, bring along a witness, like a spouse or family member, to take part in the appointment with you.

Your claim can be highly dependent on the IME, but that doctor doesn’t have the final say. You should still seek the treatment of your own physician. 

The insurance company will look for every opportunity to use your medical records against you. By taking the proper precautions, you can ensure your workers’ compensation case is as strong as possible. If you’ve been injured on the job and want legal representation before dealing with the insurance company and doctors, contact us. We can ensure you receive the protection you deserve.

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