Everything to Know about a Defense Independent Medical Exam
You were injured at work and filed a workers’ compensation claim, and now you’ve been told you need an independent medical exam (IME) requested by the Defense (Employer/Insurance Company).
An independent medical exam is a medical evaluation performed by a doctor to evaluate whether or not the treatment the attending physician recommended is correct.
It is supposed to be unbiased since it is performed by a doctor who has not been involved in the case.
Unfortunately, reality is very different. “Independent” Medical Exams are anything but independent. In fact, they are incredibly biased medical reports.
The IME doctor will evaluate the injured worker and prepare a report which will be used to justify or deny workers’ compensation claims.
It’s bad enough having to deal with the injury you sustained on the job and keeping up with your workers’ compensation claim, so it’s easy to understand your frustration at having to jump through another hoop to get the benefits you deserve.
Unfortunately, that’s just how it goes sometimes.
The good news is that an independent medical exam can work in your favor because your lawyer can obtain one for you.
However, this article is about Defense IMEs.
No matter whether it is your IME or an IME requested by the Defense (Employer/Insurer), the good news is that understanding how to best prepare for an IME will give you a much better shot at receiving an IME report that supports your workers’ compensation claim.
What Is the Purpose of an Independent Medical Exam?
Whenever you suffer a work-related injury, you need to see a doctor.
As part of the workers’ compensation claim process, you are required to see an attending physician from your employer’s posted list of approved physicians.
We always advise our clients to avoid allowing their employer to choose the authorized treating physician because they will choose a doctor that will have you returning back to work the soonest – not necessarily when you should.
While you must choose from a list, you still get to choose which doctor you’d like to see.
Let’s say the authorized treating physician you visit says you need surgery and you will be out of work for several months.
Your employer and your employer’s insurance company are not going to be happy with this news.
Insurance companies are in the business of making money – not giving money away.
If you require surgery, that costs the insurance company money. If you are out of work, it means you will get benefits while you are out of work (another thing insurance pays for).
To avoid paying what you justly deserve, insurance companies will request an independent medical exam – and they will choose a doctor who will support their position.
So, the purpose of this additional exam is to benefit the insurance company and your employer.
If they have any reason to believe you are lying about your injury or it being work-related, they will request this type of examination.
If they feel the authorized treating physician’s diagnosis and suggested treatment plan are incorrect, they will request an independent medical exam.
HG Experts explain, “It is important to understand that the independent medical examination is rarely very independent. In fact, it is usually done by an expert hired and paid for by the defendant. As a result, their findings may be contrary to what your own doctors are telling you. While the independent medical examiner is not permitted to lie, they will almost certainly review the evidence in the light most favorable to their client’s (the defendant’s) interest.”
To put it simply, the purpose of an independent medical exam is typically to save your employer’s insurance company money.
What to Do before an Independent Medical Exam
You have a much better chance of the independent medical exam working in your favor if you prepare ahead of time.
Start by finding out what the independent medical exam doctor has been told about your injury.
Generally, insurance companies will send a letter to the doctor describing the work-related incident, the medical treatment you’ve received, and what they dispute.
Ask to review this letter before your appointment. Look it over carefully to see if there are any mistakes (such as how the injury occurred).
In addition, familiarize yourself with your medical history.
The independent medical exam doctor will have access to your medical records, so they will know if you have had similar issues in the past.
Likewise, you should also be familiar with your current treatment plan, any medications you were prescribed, and the reasons why.
Go over how the injury happened. The doctor will have a summary, so they will be on the lookout for any discrepancies between your version of events and the report.
Finally, take time to think about your current symptoms and how they are affecting your daily life and work limitations.
What to Do during an Independent Medical Exam
When the day comes for your independent medical exam, arrive early and dress appropriately.
Keep in mind that dressing appropriately refers to dressing according to your symptoms or injuries rather than professional attire.
For example, if you show up wearing high heels when you are out on a sprained ankle, it’ll raise red flags.
Remember that you will be observed from the time you arrive in the parking lot until you leave the parking lot, so watch your actions carefully.
For example, if the doctor is looking for signs of a back injury and the staff reports seeing you hopping in and out of your car with ease, it’ll raise red flags.
[Related Read: Is My Workers’ Comp Insurance Company Spying on Me?]
If possible, take a trusted friend or family member with you to the appointment so they can take notes for you. You are also well within your rights to record the audio of the examination on your phone.
Most importantly, during the independent medical exam, be honest. Don’t try to exaggerate your symptoms. Never say that your pain level is a 10/10. If you do, it’ll raise even more red flags.
What to Do after an Independent Medical Exam
Once the independent medical exam is complete, make sure to get a copy of your friend’s/family member’s notes.
If you were unable to bring a friend or family member with you to the appointment, take a few minutes to write down your own notes about the examination or double-check to make sure your phone recorded and saved the audio.
After you receive the doctor’s report from the independent medical exam, read it over carefully.
Be on the lookout for any mistakes – specifically those that have affected the doctor’s recommendation.
Should the report suggest you do not deserve treatment, it is time to meet with an experienced workers’ compensation attorney.
A workers’ compensation attorney will fight for you to receive the benefits you need by challenging the findings in an independent medical exam.
What You Should Know about Independent Medical Exam Doctors
Unfortunately, there are some doctors who are less than ethical, and some of these doctors find their careers providing independent medical exams. They’re hired guns.
Since their salary is dependent on the insurance companies, many of these IME doctors will write reports that benefit the insurance company more than the injured party.
The Center for Justice and Democracy at New York Law School explains, “As part of a recent three-part series, the New York Times reviewed ‘case files and medical records and interviews with participants’ that ‘indicate that the exam reports are routinely tilted to benefit insurers by minimizing or dismissing injuries.’”
In addition, the CJD at New York Law School reports, “In 2004, a study found that the Central New York Occupational Health Clinic’s doctors almost never agreed with independent medical examiners on the disability of their patients.”
Given that many of these semi-retired doctors are in the insurance company’s pockets, it is wise to hire an attorney to help you navigate the independent medical examination process.
If you’ve been injured on the job, contact us today for a free, no-strings-attached consultation.
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