The Truth About Workers’ Compensation Doctors and Independent Medical Exams

Nervous about having an independent medical exam? You should be. Learn how insurance firm doctors can make or break your workers’ compensation audit. Navigating the workers’ compensation medical process can add even more discomfort to a painful work injury. Each state has its own rules and regulations regarding workers’ comp claims, but one rule is common to all:

Injured workers seeking benefits must be evaluated and diagnosed by workers’ compensation doctors approved by the employer’s insurance firm.

For many injured workers, that means facing an Independent Medical Examination, or IME ordered by the workers’ compensation insurance company.

Can You Be Forced to Have an Independent Medical Exam?

If you’re injured on the work and making a workers’ compensation claim, you want to be medically evaluated and treated by doctors who are approved by your employer’s insurance firm.

Virtually all state regulations permit you to be treated by your own doctor, but your claim is very hooked into the medical opinion of the doctor from the insurance company’s approved list.

Several circumstances may cause the insurance firm to request that you simply undergo an Independent checkup (IME).

The insurance firm calls it an invitation, but the hard truth is that if you refuse to undergo the IME, your claim is going to be flatly denied. Game over.

Remember that the workers’ comp insurance firm will do whatever it takes to save lots of money. That means limiting benefits and wage payouts to injured workers such as you.

The fastest way for the insurance firm to justify limiting your workers’ comp is to possess medical “proof” that you’re able to return to figure.

IME Doctors Work for the Insurance Company

Doctors have various reasons for deciding to figure for an insurance firm, but like most of the people within the workforce, their goal may be a paycheck.

Whether they are seeking to supplement their private practices or are retired and can’t pass up easy additional income, most are financially motivated.

Workers’ Comp Doctors Protect Company Profits

Workers’ compensation doctors know insurance companies don’t like pocket money on expensive tests like MRIs and CT scans. These tests are expensive and complicate the whole claim.

Even when doctors would normally recommend those diagnostic or therapeutic services, in workers’ comp cases, they won’t mention it to the injured worker. It’s easier for the IME doctor to only side-step having to affect your frustration or an issue with the insurance firm.

As a result, many insurance company-approved doctors are more likely to treat injuries with pain medication. Pills are much less expensive than an MRI.

Workers’ comp IME doctors know that if they verify the severity of your injuries, the insurance firm will need to pay your benefits accordingly. They also know the insurance firm won’t love it.

To remain on the list for workers’ comp referrals, some doctors may classify patients as malingerers, instead of diagnosing real pain issues and injuries with implications for long-term disability.

Workers’ Comp Doctors Don’t Care About You

There is no such thing as a very independent checkup. Doctors hired to perform IMEs are paid by the workers’ comp insurance firm handling your claim. In most cases, the adjuster working your claim chooses the IME doctor you’ll be required to ascertain.

Remember, if you refuse to undergo an IME, the insurance firm can legally deny your workers’ compensation claim and stop your medical and wage replacement benefits.

What To Do Before, During and After an IME

How to Get Ready for an Independent Medical Exam

You can’t refuse the insurance company’s request for an IME or you’ll risk losing all of your workers’ comp benefits. But, you’ll ratchet back a number of the strain of facing an IME by brooding about what you’ll be asked by the doctor and being prepared to offer complete and honest answers.

If possible, have a lover or relative accompany you to the IME. It never hurts to possess your own witness to the exam. They won’t be allowed to talk but ask them to require notes.

What are the issues?

The insurance firm will send copies of your medical records to the IME doctor well before the scheduled exam date, usually alongside a canopy letter telling the doctor what they want to know about your condition.

Try to get a copy of that letter. You need to understand if the insurance firm has misinformation about you, so you’ll correct mistakes. Make the request in writing and send a replica of your request to your state’s workers’ comp board.

How did the accident happen?

Review exactly how the accident happened and be prepared to re-tell the small print to the IME doctor. Yes, the doctor should have that information from your medical records, but they’ll want to listen to it from you.

Take your time. The IME doctor is going to be trying to find inconsistencies in your story, so don’t let anyone rush you. Don’t volunteer your opinions, just relate the facts.

What to Expect During Your IME

You have no right to confidentiality with this checkup. Everything you say or do is going to be reported to the insurance firm and may be used against you.

You’ll be observed from the time you reach the IME location. They’ll be looking to ascertain if you hop easily out of your car and walk briskly to the building, only to limp and groan as you struggle to ease into a chair within the lounge.

What’s your medical history?

Don’t try to conceal pre-existing conditions. If you’ve got prior injuries or a pre-existing medical condition, be prepared to explain how this work injury and it affects you is different and distinct from your condition before the work injury.

How are you today?

Tell the IME doctor every detail about your pain management, mobility struggles, and the way your work injury affects your activities of daily living. Don’t exaggerate, but don’t leave anything out.

There could also be details that are embarrassing but are impacting the standard of your life. If you haven’t been ready to dress since the accident, or sometimes have trouble making it to the toilet in time, you want to speak up.

Remember that insurance companies often have injured workers under surveillance. If you say you can’t drive, lift or bend, you’ll forfeit your workers’ comp claim if the insurance firm has videos of you loading groceries into your car.

Be on time and be careful. Whether the IME doctor and staff are pleasant or rude, you ought to be polite and always think before you speak.