Many workers must see multiple doctors when they file a workman’s compensation claim. Insurance companies, lawyers, or other professionals must determine your work-related injuries and how they impact your life before moving forward with a claim. This is why they request an IME, which stands for independent medical examination.
Many injured workers face this step in the workers’ compensation process. It happens when the insurance company or employer wants an unbiased opinion regarding your condition. There’s more to it than just another doctor’s visit.
It’s common to feel skeptical about another doctor’s appointment. An IME can have a significant impact on your worker’s compensation benefits. This article will review everything you need to know ahead of your independent medical exam and how an experienced workers’ comp lawyer can help with your case.
Purpose of Independent Medical Examination
An independent medical examination (IME) is a medical examination performed by a doctor not involved in your regular care. It’s a way for the insurance company to get a second opinion on your injury or treatment. They might want to see if your condition is as severe as the claim states or if your medical treatment is necessary.
IMEs are a standard part of many workers’ compensation cases. They’re usually requested when there’s a disagreement about your injury, your medical treatment, or your ability to work. The IME doctor will review your medical history, review relevant medical records, and perform a physical examination. After that, they’ll write an IME report for the insurance company.
Who Requests it
The insurance company or your employer typically asks for the IME. They might think your injury isn’t work-related or that you’re ready to return to work sooner than you say. An unbiased opinion from another doctor provides information to clarify how severe the injuries are.
When the Insurance Company Requires It
An insurance company usually calls for an IME when there’s a dispute. They may think your condition is due to a pre-existing injury or are unsure if you’ve reached maximum medical improvement.
Sometimes, they want to reduce your workers’ compensation benefits. In these situations, the IME becomes a tool to back up its position with evidence from an independent medical examiner.
The IME Process
Getting an independent medical examination (IME) can be intimidating, especially when healing from a work-related injury. Understanding how the process works can make it easier.
The IME is a formal medical examination used to evaluate your condition. It’s requested by the insurance company to get a second opinion on your injury, treatment plan, or ability to return to work.
Selecting the Doctor
First, you should know that you usually don’t choose the doctor for your IME. The insurance company picks a doctor who is not your usual treating physician.
This independent medical examiner is supposed to be neutral, but it’s well-known that physicians often have long-standing relationships with insurance companies. Doctors are hired to review your medical history and records, perform the exam, and give their own opinion—one that may or may not match your treating physician’s opinion.
The Examination
The IME is typically different from standard examinations. The IME doctor will ask detailed questions about how you got injured and its impact on your daily life. They’ll likely conduct a physical exam, including tests to see your range of motion, strength, or pain levels.
The IME doctor will review your medical records to understand your health and treatment history. Sometimes, they may ask you questions that seem repetitive or unrelated to your injury. It’s essential to answer truthfully and stick to the facts. Remember, the IME doctor is looking for inconsistencies, so it’s best to be clear and straightforward.
The Report
After the examination, the IME doctor will write a report summarizing everything. This report will include their findings, opinions on your condition, and treatment recommendations (if any). The report is sent directly to the insurance company, not you.
This report can significantly impact your workers’ comp claim, primarily if the IME doctor’s conclusions differ from what your treating physician has said. If you’re worried about the report, an experienced workers’ compensation attorney can help you understand and, if necessary, challenge it.
How the IME Affects Your Workers’ Compensation Claim
Independent medical examinations can significantly impact your workers’ compensation case. The IME plays a large role in determining the severity of your injury, determining if you’re eligible for benefits, or deciding what treatment you need next. How does it influence your claim?
Determining Eligibility
After the doctor reviews your medical history, performs a physical exam, and looks at your treatment plan, they’ll write a report. This report goes directly to the insurance company and can influence whether your workers’ compensation benefits get approved.
If the doctor thinks your condition isn’t as serious as your treating physician believes, the insurance firm might deny your claim or cut off your benefits. This report is critical because it could be the deciding factor in your workers’ comp case.
Assessing Impairment
One of the main reasons insurance companies request independent medical exams is to assess how much your injury affects your ability to work. IME doctors might give you an impairment rating, which measures how much your injury limits your physical capabilities.
A high impairment rating usually means your injury is more severe, while a low rating could mean the insurance firm will push you to return to work sooner than you’re ready. This impairment rating directly affects how much compensation you could receive.
Determining Treatment
The report can also impact decisions about what kind of medical care you’ll get moving forward. For example, if your doctor has recommended a specific treatment, like physical therapy or surgery, and the IME physician disagrees, the insurance company could deny coverage.
They might suggest alternative options, which could delay or disrupt your recovery. This can be incredibly frustrating for the injured worker who just wants to recover.
If you think the report isn’t accurate or fair, you don’t have just to accept it. An experienced workers’ comp attorney can help you challenge the findings and advocate for the medical care and compensation you deserve. Having someone in your corner who understands the process and can guide you through these tricky situations is always a good idea.
Preparing for an IME
Getting ready for an IME is essential. How you prepare could significantly impact your workers’ compensation case. You might think it’s another standard medical exam, but it’s not the same as visiting your regular doctor.
The IME physician will evaluate your condition on behalf of the insurance company, and their report will play a massive role in the outcome of your workers’ compensation claim. It’s crucial to go in ready and know what to expect. Let’s review key steps to help you prepare and protect your rights.
Gather Medical Records
Before your IME, gather all your medical records related to your injury. This includes doctor’s notes, treatment plans, test results, and any other paperwork showing your medical history. Review everything so you’re familiar with the details of your condition.
A clear understanding of your medical records will help you explain your symptoms and treatments to the doctor without confusion. You’ll also be better prepared to answer questions accurately.
Be Honest and Accurate
Honesty is the best policy when it comes to your IME. The doctor might ask you to describe your pain, how the injury happened, or how it affects your daily life. Always be straightforward with your answers. Don’t exaggerate your symptoms or leave out essential details.
For example, say so if your pain is mild on some days and severe on others. Being truthful and accurate builds credibility; the doctor is trained to spot inconsistencies. Any slip-up, even a small one, could hurt your worker’s compensation case.
Follow the Doctor’s Instructions
During the examination, the doctor might ask you to perform specific tasks, like bending over, raising your arms, or walking a few steps. It’s essential to follow their instructions as best as you can. Don’t overdo it; do what you can, and let the doctor know if you can’t perform a specific task.
Following the doctor’s instructions shows cooperation and helps provide a clear picture of your condition. If the doctor recommends follow-up actions, like additional tests, consider following through, but talk to your treatment physician and your attorney first.
Consult with an Attorney
Speak to an attorney about your workers’ compensation case before the IME. An attorney can explain what to expect, how to answer questions, and how to handle uncomfortable situations during the exam. They might advise you on what to look for and how to document your experience after the IME.
Some workers’ compensation attorneys may recommend someone accompany you to the appointment if that’s allowed in your area. This support can be beneficial, especially if you feel nervous about the exam. Preparing for an IME can feel overwhelming, but these steps will help you feel more confident and better protected throughout the process.
What to Do if You Disagree with the IME Report
You may disagree with the IME report you receive. For example, if it says your injury isn’t as severe as you and your doctor think or you can return to work when you’re not ready. This happens more often than you realize. If the report seems unfair, you can fight back and get the workers’ compensation benefits you deserve.
Options for Dispute
If you disagree with the report, you can start by getting a second opinion from your doctor or a specialist. This second opinion could provide more evidence to support your case. Another option is to request a hearing with the workers’ compensation board to dispute the report.
At the hearing, you’ll have a chance to present your side, and they’ll look at the medical evidence, including your doctor’s opinion. It’s also important to point out any mistakes in the report that might have affected the IME doctor’s conclusions. This can include factual errors or overlooked information.
How a Lawyer Can Help
This is where having an attorney on your side helps. A workers’ compensation attorney knows how to challenge an unfair report. They can gather additional medical evidence, prepare for the hearing, and argue your case. They’ll question the IME doctor’s qualifications and look for signs of bias if needed.
Having a lawyer who understands the ins and outs of workers’ compensation can make a big difference in the outcome of your case. If you’re facing a tough report, don’t hesitate to get legal support.
Secure Expert Legal Counsel!
If you’re dealing with a problematic report or need someone on your side throughout the workers’ comp process, it’s a good idea to connect with an experienced lawyer. Our team at Rosenfeld Injury Lawyers is here to help you understand your options and protect your rights. We’ve successfully handled countless workers’ compensation claims and are available 24/7 to talk.
Call us at (888) 424-5757 or fill out our contact form to set up a free consultation with a Chicago work injury attorney.