Independent Medical Exams (IMEs) in Workers’ Compensation Cases
If you’ve been injured in a work-related accident, you are entitled to time off work to recover from your injuries.
Sometimes, there are disputes between your treating physician and your employer’s insurance company about whether or not you can return to work, or the extent of your injuries. In these cases, you will be asked to submit to an Independent Medical Exam (IME).
What Is an IME?
An IME is a thorough physical examination, conducted by a doctor who has not previously treated you, to test the extent of your injuries or impairment, and determine whether you are sufficiently healed to terminate workers’ comp benefits and return to work.
The doctor conducting the IME should, at least in theory, be a neutral third-party. Their report can have a great impact on your workers’ comp case.
Who Chooses the Doctor for an IME?
In most states, if the insurance company requests an IME, they also select the doctor who performs the IME.
This can create a conflict of interest, as the doctor receives payment from the insurance company and, therefore, has incentive to help the insurance company keep their costs low. Because of this, the doctor performing the IME may minimize the extent of your injuries in their report.
Some states also allow you to request an IME if you disagree with the options presented by your treating doctor.
In these cases, you have the opportunity to select the doctor performing your IME.
What Happens During an IME?
Prior to the IME, your medical records and other documents relevant to your case are sent to the IME doctor. This doctor has the opportunity to review your documents prior to your exam, or after it.
If there is an issue that is causing a great deal of conflict between you and the insurance company, the insurance company may write a letter to the doctor that explains your injury, summarizes your treatment to date, and poses specific questions regarding your medical condition. This letter is used to frame the issues at hand for the doctor.
Some questions the insurance company may pose in this letter include:
- Whether or not your condition has been properly diagnosed
- Whether your injuries or illness were truly caused by a work-related accident or exposure and not personal activities or off-duty conduct
- Whether or not you need additional medical treatment or testing, and what sort of treatment or testing you need
- When you will be able to return to work, and whether you need restrictions to return to work
- Whether or not you have a permanent disability
If the insurance company sends a letter to the IME doctor, you should ask to review this letter so you can correct any factual mistakes and make sure the questions asked are appropriate in your case. Make these requests for changes in writing and file a copy with the state agency where your case is pending.
You should not go into an IME with any expectation of privacy or privilege between yourself and the doctor.
This means that anything you tell the doctor can be used in their report back to the insurance company. Additionally, anything the doctor observes about you, even outside the bounds of the IME, can be included in their report on your condition.
For example, if the doctor notices you walking normally into the office but you spend the entire IME limping and favoring one leg, they will make note of this and include it in their report.
During the examination, the doctor will ask you questions about your injury, your relevant medical history, and the course of your treatment. They may conduct a physical exam or tests, such as measuring your range of motion or ability to stand for periods of time, recording the results in their report.
How Will an IME Affect My Workers’ Comp Case?
Following your IME, the doctor writes a report with their conclusions and opinions, especially concentrating on any disputed issues or questions raised by the insurance company.
You or your attorney should receive a copy of the report.
The IME doctor’s report can have a major impact on your workers’ comp case. Judges and hearing officers view IME doctors as experts and give a significant amount of weight to their reports. IME doctors are also seen as more impartial than treating physicians, and their findings are given precedence in determining a workers’ comp case.
If the doctor’s report states that your injuries are not as serious as your treating physician says, that they didn’t truly arise from a work-related accident, or other matter that disputes what you are saying about your case, the IME could result in you losing your workers’ comp benefits or having to return to work before you are ready.
Can I Challenge an IME Report?
It is often very difficult to challenge the results of an IME, but there are some cases where it can be effective.
If you receive the report and note that the doctor’s opinion is based on incorrect information about your medical history or another factual error, it’s important to point that out as soon as you notice. To do this, write a letter to the doctor and insurance company explaining the mistake and supporting it with documentation from your medical records, if possible.
Your letter also should request that the doctor clarify their report with an addendum.
Some states also allow you to request a second IME, performed by a doctor of your choosing.
Workers’ Compensation Attorney in Washington, D.C.
Your workers’ comp case deserves the time and attention a skilled, experienced lawyer can provide. Even the simplest of cases can quickly spiral into a headache of paperwork and appeals, something you don’t need to handle while you’re trying to recover from your injuries.