Employers and employees understand the importance of medical examinations in a workers’ compensation claim. The medical expertise of a physician can help to answer certain questions related to a work-related injury. However, sometimes, employees do not have the option of seeking the medical care of their primary care physician.
Employees may have to choose a treating physician from a recommended list of physicians provided by the employer. Employees may also become involved in a dispute with the employer’s insurance company about certain information related to a work-related injury. When employees are in this particular situation, an independent medical evaluation (IME) may be requested by the insurance company.
Often, an employer’s insurance company will attempt to question the validity of their employee’s injury. In this situation, an employee will be asked to undergo a medical evaluation known as an independent medical examination. An IME is an allegedly “neutral” medical evaluation used to resolve questions about an employee’s medical condition for a workers’ compensation claim. (We will address this neutrality in a bit.)
What is the purpose of an independent medical examination?
The purpose of an independent medical examination is to allow an insurance company to get their own medical opinion regarding a disputed issue related to an employee’s workers’ compensation claim. An IME is requested by the insurance company when the company disagrees with a decision by the treating physician about an employee’s medical treatment or the extent of their injury. In some cases, a judge in a workers’ compensation case may also request an independent medical examination.
What happens during an independent medical examination?
Before the independent medical examination can take place, the employee will be asked to submit medical records and any other documents that are relevant to their injuries. The physician has the option to review the documents before or after the examination. In addition to medical records and supporting documentation, the insurance company will write a letter to the physician regarding the employee’s injury, the course of treatment, and specific questions about the employee’s medical condition. The questions the insurance company poses will be used to frame the examination for the physician.
Who chooses the physician for an independent medical examination?
When it comes to choosing a particular physician to conduct the independent medical examination, under Pennsylvania law, your employer’s insurance company chooses the doctor who administers the IME. The physician will review the employee’s medical records, examine the employee, and write a report that details the extent of your injuries and the potential treatment.
There are many perfectly good IME physicians out there who will give you an honest, neutral assessment of your injuries. However, they are hired by an insurance company which is likely not at all neutral about the outcome. Because of this, you may wish to seek a second opinion from your own doctor. If your own physician’s review completely contradicts what the IME physician says, it may prove helpful to you later, especially if you are denied benefits.
What is the role of treating physicians in workers’ compensation claims?
The treating physician plays a significant role in a workers’ compensation claim. Unlike an IME physician, who meets with an employee once for as little as 10 minutes and then gives an assessment, a treating physician will monitor an injured worker’s recovery over time. The treating physician is responsible for making important decisions in a workers’ compensation claim that can affect the recovery time and benefits the employee is entitled to receive. The good news is that in PA, after treating with employer panel physicians for 90 days, injured workers can use their own doctors as treating physicians
Some of the important decisions determined from the expertise of the treating physician are the type of work restrictions for an injured employee, the professional medical diagnosis of a work-related injury, referral to particular specialists, whether a work-related injury is a permanent disability, and valuable medical documentation for the claim.
How does an IME affect a workers’ compensation claim?
After the independent medical examination is conducted, the physician will write a report with their final conclusions and opinions concerning any disputed issues or questions raised by the insurance company. The employee is also able to request a copy of the report. The results of the independent medical examination are substantial, as insurance agencies and workers’ compensation judges view physicians as experts.
Judges may also view independent medical examination physicians as more objective than treating physicians, even if that is not always the case. This impartial view of independent medical examination physicians may make it difficult for an employee to discredit the physician’s opinion.
Can employees challenge the results of an independent medical examination?
Yes, there are circumstances where an employee can challenge the results of an independent medical examination. One of these involves whether the physician’s opinion is based on incorrect information about an employee’s medical history or another factual mistake. Employees will want to point out any incorrect information right away.
Employees can point out any faulty information by writing a letter to their attorney describing the mistake and supporting it with documentation from their medical records.
What should I do before an independent medical examination?
If possible, an employee should seek the assistance of a workers’ compensation attorney once an independent medical examination has been requested. The employee should also schedule an appointment with their treating physician to occur as soon as possible after the IME. This will allow your own physician to provide his or her own opinion regarding your medical condition and work capabilities around the same time the IME physician sees you, which will be very valuable should the IME doctor’s opinions be unfavorable.
At KBG Injury Law, we take your injury as personally as you do. We advocate on your behalf to get you the results you deserve. If you have been injured on the job and have questions or feel you are not getting the workers’ compensation benefits you are entitled to, call us today at 717-848-3838 or complete our contact form to schedule a free initial consultation. We represent clients in York, Lancaster, Hanover, Harrisburg, and Gettysburg.
The personal injury attorneys at KBG Injury Law are all experienced litigators. Almost all of them represented insurance companies prior to becoming advocates for injured people, which provides them with a unique perspective and insight into how these companies operate. They also offer extensive courtroom experience if going to trial is the best legal alternative for the client.