Independent Medical Examinations in Workers' Compensation Claims
Sometimes a dispute arises in a workers’ compensation claim regarding the severity of a worker’s injuries. In other cases, an insurer may dispute the causal relationship between the claimant’s job and their condition. Or it may object to the treatment proposed by a doctor. If the insurer disagrees with the opinions of the worker’s doctor, it may require the worker to undergo an independent medical examination. Alternatively, a judge may order an IME to determine a contested issue in a workers’ compensation claim. The IME is meant to provide a neutral opinion about a worker’s medical condition. Whether it is actually unbiased remains open to question, as explained below.
Choosing a Doctor for an IME
The insurer usually is responsible for choosing the doctor who will perform the IME. Since the doctor is paid by the insurer to conduct these examinations, they likely have an incentive to produce an opinion that favors the insurer. This will encourage the insurer to continue retaining their services. Therefore, many observers believe that IME doctors are not truly neutral, as the system envisions.
Not all states give the insurer unlimited control over choosing the IME doctor. The insurer may be required to choose from a list of randomly selected specialists. In other states, while the insurer can demand an IME, the judge hearing the case will choose the doctor. If the injured worker has a lawyer, they may get more protections.
In the rare event that the injured worker disagrees with the opinion of their own doctor, they may be able to request an IME in some states. This generally would mean that they would choose the IME doctor.
The Examination
The doctor will receive the medical documentation related to the injured worker’s injuries, which they may review before or after the IME. Sometimes the insurer will send an additional letter to the doctor, encouraging them to focus on certain issues that are disputed in the claim. These may involve causation, the accuracy of the treating doctor’s diagnosis, the necessary treatment for the condition, the worker’s ability to return to work, the duration and extent of any disability, or a combination of these factors. An injured worker should ask in writing to receive a copy of any letter sent by the insurer to the IME doctor. This will allow them to correct any problems with the insurer’s description of the case.
You should be aware that you do not have a doctor-patient relationship with the IME doctor. Protections such as the duty of confidentiality generally do not apply. The insurer may use evidence from the IME doctor’s report against you at a workers’ compensation hearing, including any statements that you make to the doctor. Part of the purpose of the IME, from the insurer’s perspective, is to collect evidence that can undermine a worker’s credibility at a hearing. While you should be honest with the IME doctor, you should not downplay the severity of your injuries. You can feel free to correct the doctor if they make a false assumption or ask a leading question.
Challenging Unfavorable IME Results
The IME doctor will talk with the worker, conduct physical tests, and review the documentation. They will compile a report based on all of their observations and conclusions, which they will send to both sides. You should make sure to review this report in detail, since it likely will carry substantial weight with a judge. Although this may not be justified, a judge often will view the opinion of an IME doctor as more persuasive than the opinion of the worker’s treating doctor.
This can cause difficulties if the report is inaccurate or misleading. You should make sure to correct any objective errors in the report. In a letter to the doctor and the insurer, you can identify the mistakes and produce medical documentation to support your position. You may be able to ask the doctor to correct the report, or you may even be entitled to get a second IME, for which you can choose the doctor.
If you retain an attorney, they may question the IME doctor at a deposition and use other litigation tactics to minimize the impact of an unfavorable IME. They also can assist you with collecting further medical evidence and arranging an additional IME as needed.
