If you have been injured at work, you have likely started to deal with the workers’ comp claims process. This process can be lengthy and demanding, from seeking treatment to making sure you get the benefits you deserve.
One thing that is a frequent part of the process and something that many claimants worry about is an Independent Medical Exam (IME).
It is not uncommon for your employer’s workers’ compensation insurance to request that you attend a medical examination with a physician of its choosing. This is the insurance company’s way of getting a second opinion to verify and possibly dispute, your injuries.
Many people worry that the results of their IME will give the insurance company a reason to deny benefits. If you have been requested to attend an IME, there are some things you should know about the IME process and how to prepare
“Do I Have to Attend an IME?”
Lots of people are asking “Do I Have to Attend an IME?” – we have the answers for you.
If the insurance company has requested you to attend an IME, you are not legally obligated to attend. However, refusal to attend may prompt the insurance company to deny benefits, making it imperative to attend.
The insurance company has the right to ask you to attend an IME and to cut or deny benefits if you do not attend subsequently.
So, if you receive notice that you are being requested to undergo an IME, you should make plans to go and speak to your lawyer, who can guide you through the process.
What is the Role of an IME Physician?
An IME physician is an “independent” physician chosen by the insurance company.
We say “independent” because many of these doctors are anything but.
IME doctors work for the insurance company, and many have pre-existing relationships with insurance companies that allow them to get patients in exchange for giving an opinion that is favorable to the insurance company.
Because there may be a financial incentive to clearing you for work or reporting that your injuries are not as bad as initially diagnosed, many people worry that these doctors will automatically disagree with their first doctor.
While this may be the case, rest assured there are physicians out there who will take their patient care responsibilities seriously and give their honest account of your injuries.
There are also ways to combat an opinion that is contrary to your first physician’s report so that you can continue to receive benefits.
What Can You Expect at Your IME?
At your IME, you will likely be under heavy observation from the time you walk into the door.
The IME physician has been hired by the insurance company and will be reporting his or her findings to it, including how easily you seem to be able to handle daily tasks (such as walking, standing, etc.).
The actual exam will likely be very much like any other medical exam, except that the IME physician will already have a copy of your medical records and previous doctors’ notes. Using these, in addition to the insurance’s request, the doctor will ask you questions and may look at specific issues rather than doing a complete examination.
The examination will likely be quite short. While there are exceptions to this, most IME physicians have an idea of what injuries they are trying to confirm or dispute, and these doctors make money per patient, encouraging them to see as many patients as they can in one day.
It is not unheard of for an IME physician to order specific tests or prescribe treatment, only for the patient to later be left with the bill because they were medically unnecessary. This is usually the case when the doctor has a financial interest in a company that supplies medical supplies or medical centers.
It is important to keep track of anything ordered by the worker’s comp doctor and what those treatments are for; that way, you have noted if you encounter this situation later.
A Few Things to Consider Before an IME
Before you attend an IME, you should be prepared to do a few things and carefully consider what you will be asked. An IME is something that should be taken seriously and approached carefully, so it is important to be prepared.
- Be prepared to answer questions honestly. Although it may seem like downplaying your previous medical history and embellishing symptoms may help your case, this is the opposite of the truth. You should be candid with the IME physician, even if you think they are not there to help you. Report all medical history and answer all questions honestly. IME physicians are still doctors, and many doctors are trained to spot when patients are lying or exaggerating about symptoms. If the physician feels you dishonest and reports this to the insurance company, this can be detrimental to your workers’ comp claim.
- Get copies of your medical records for your review and to take along with you. While the IME doctor will likely have copies of your medical records and previous doctors’ notes from the insurance company, it is a good idea to obtain copies for yourself so that you can review them. This way, you can go into your IME with a clear idea of what issues the doctor is likely looking at, and you can correct any information you think is incorrect.
- Let the doctor know about any new or worsening conditions and any restrictions on your activity. If you have developed new symptoms or your pain is worse since your first visit, report this to the IME doctor. It is essential to update the doctor about your injuries so that the doctor can consider them when reporting on your condition. Also, report whether you have any new or worsening effects on your ability to do daily activities.
- Be prepared to give details about the accident that caused your injuries. The IME physician will most likely have a copy of any accident reports or your account to your employer, but you should be prepared to give details about the accident and recount what happened. The IME physician may report your account to the insurance company for comparison to your original statement. However, it will also help the doctor focus on what injuries you have from the accident and highlight those findings in his or her report.
- Consider taking notes about the details of your exam. Taking notes about your IME, including the doctor’s interactions with you, any diagnoses or treatment plans, and any other pertinent information, can be helpful if you need to recount the details later.
What Should You Do After an IME?
- Request copies of any records or reports. Review these for accuracy, and take note of any mistakes that you may need to challenge. Let your attorney know if anything in the reports is incorrect.
- Make sure you have detailed notes about your visit and compare these to any records. Review the notes you took on the visit, and see if they match up with the records from the visit. This will help you determine whether there are any discrepancies between your account of the visit and what the doctor reported.
- If you have a workers’ comp attorney, give them all documentation and inform them about the visit. Give your workers’ comp attorney copies of medical records, doctors’ reports, and any paperwork from the insurance company. Your attorney will review the paperwork and will be able to determine the appropriate steps forward.
Contact an Experienced New York Workers’ Compensation Doctor Today
Whether you are in the early stages of the workers’ comp claims process or seeking a second opinion, our New York physicians have the necessary experience to diagnose and treat your injuries.
Our doctors have extensive experience treating workers’ compensation patients in New York, and our duty is to our patients — no matter who has requested the exam.
For questions about workers’ compensation medical examinations, or to find an experienced workers’ comp doctor near you, call (888) 590-4030 today!