Generally, when you have a workers’ compensation case, your treating doctor will make most—if not all—of the decisions about your health, your treatment, temporary or permanent disability, and your ability to work. If, however, your employer’s insurance company disputes any of this, you may be asked to go through an independent medical exam (IME).
An independent medical exam is pretty much what it sounds like. You’ll be asked to see an independent doctor and allow that doctor to assess your condition. It is literally the insurance company’s way of asking for a second opinion.
There is nothing inherently wrong with being asked to go through an IME, but the opinion of this second doctor can have significant consequences to your workers’ comp claim. The new opinion could affect the benefits you’re getting or even your right to continue collecting any benefits at all. It’s important to know how an independent medical exam works and what you can do if the second opinion is not one that favors your case.
How The Doctor For An IME Is Chosen
The doctor to conduct the exam will be chosen by your employer’s insurance company. The doctor is supposed to be a neutral party, but, as you’re probably thinking, there is most likely going to be at least some bias.
It’s safe to assume that you are not the only patient the insurance company has asked this doctor to examine. This, of course, creates a financial incentive for the doctor to do things that will prolong his or her relationship with the insurance company, whether either of them admits it or not.
What An IME Is Meant To Determine
The doctor performing the IME will normally receive all information relevant to your claim prior to meeting with you. He’ll usually receive your injury report as well as any medical records regarding your current condition and how you’re being treated. It’s also likely that the insurance company will send along a list of questions that they’d like answered and any points about your condition or treatment that they feel are being dealt with incorrectly.
Questions to be answered might include things like:
- Is the original diagnosis correct?
- Is the condition undoubtedly related to a workplace accident or injury?
- Is currently recommended treatment or testing really necessary?
- Will you be able to return to work? When? Under restrictions?
- Is there a permanent disability? Can an impairment rating be determined?
It’s also worth noting that during this exam there is no expectation of the normal doctor-patient relationship. This means that nothing you say to each other falls under doctor-patient confidentiality. Things you say or do in the doctor’s office may be used during legal proceedings in your workers’ compensation case.
How You Can Prepare For An Independent Medical Exam
There are several things you can do to prepare yourself for an IME to help make the process as smooth and painless as possible.
Ask To See The Information Provided By The Insurance Company
It is in your best interest to ask to see any documentation that the insurance company has provided or intends to provide to the IME doctor. If there are any errors, you’ll have the chance to correct them. It will also give you an idea of what the doctor will be looking for during the exam.
Review Your Own Case
You should take some time to make sure you have a clear understanding of your own case as well as how and when everything happened. If the doctor has questions for you, you should be able to answer them quickly and honestly. It’s not good if it looks like you’re thinking too much or making up answers.
How To Conduct Yourself During An Independent Medical Exam
First, you should plan to arrive early for your appointment. If you’re late and miss your exam, you run the risk of having your benefits suspended. Then, of course, you should be polite and respectful to the doctor and staff at the office.
Beyond that, keep the following in mind:
- Be truthful and resist any urge to exaggerate.
- Be consistent. Your answers should match documentation.
- This is not your doctor. Don’t ask for advice or volunteer information.
- Be careful and precise when talking about any prior injuries.
- Be clear about your current injury-related limitations.
What You Can Do If The IME Works Against You
Your best chance for challenging an unfavorable IME result is if you can prove that the exam results are based on incorrect information or some kind of mistake. If you think the doctor’s opinion is based on bad information, you should contact the doctor and the insurance company and tell them so. Be prepared to back up your claim with your medical records and solid documentation.
If you can’t get the matter resolved with the doctor or insurance company through informal channels, you should contact a qualified workers’ compensation lawyer. A lawyer will be able to help you protect your rights and benefits by filing formal objections, scheduling a deposition to question the doctor on the matter, or possibly requesting another examination with a different doctor.
Our team at Solnick & Associates has both the knowledge and experience to get results from Pennsylvania workers’ compensation claims. If you’ve been injured at work and need to file a claim or if you’ve run into problems with a current claim, we can help. Contact us online or call (877) 415-6495 to schedule a free consultation. We’ll go over the details of your case and discuss exactly what we can do to help you.