What is an Independent Medical Examination & How Does an IME Impact my Workers Comp Case?
After an on-the-job injury in Arkansas, one of the first steps when filing a workers’ compensation claim is to visit the treating doctor for examination of your injury. This is an important step in getting a diagnosis, as well as much-needed treatment.
However, your treating doctor is not the only one that will likely examine you. Your employer’s insurers are allowed to contract an independent medical examiner to examine you, too. The purpose of independent medical exams (IME) is to act as a cross-reference, ensuring workers are not exaggerating their injury.
This IME is important to insurance companies because there are over 4.5 million workplace injuries every year. These injuries result in payouts of over $62 billion and workers’ compensation insurers want to be sure that they are not paying more than is absolutely necessary. As a result, independent medical exams are often a requirement when seeking benefits.
Unfortunately, although the word “independent” is in their title, these examinations and the physicians who conduct them are not completely sovereign from the insurance company. In 2009, the New York Times found in a review of case files, medical records, and interviews that IME reports tend to benefit insurers.
For this reason alone, it is important to have someone on your side who can help you through the initial IME. You need a workers’ compensation attorney who can prepare you for the initial meeting with an independent medical examiner, so you can obtain the compensation and benefits you rightfully deserve.
What is an IME?
Independent medical examiners are often semi-retired physicians who are older and no longer treating patients. The only requirements to become an independent medical examiner are to have a state medical license and be authorized in a specialty.
Physicians can make appointments for independent exams on their own time, maintaining their own schedule and freedom. Very little equipment is needed and there is no physician-patient relationship, absolving the IME of potential liability. Overall, it can be lucrative part-time or full-time work for a physician looking for flexibility.
The purpose of an Independent Medical Examination (IME) is for the insurance company to gather information about your injuries to help them determine whether to award or deny your workers’ compensation benefits. There is no medical treatment prescribed and no advice given about your injuries. The examination is simply for the insurance company’s benefit.
Insurance companies are notoriously suspicious of many workers’ compensation claims, especially soft tissue injuries. As such, they want to be sure they are paying out only legitimate claims. An IME is a way for them to “double-check” that your injuries are what you claim they are and that you truly suffered these injuries while in the course of employment.
They also want to know when you can begin to return to work. An IME can help them determine if you are able to resume your daily work activities and whether you have a right to still collect benefits.
How is an IME Chosen?
Depending on the injuries and issues you face, insurance companies may ask you to undergo more than one IME. For example, they may want you to visit an orthopedic surgeon as well as a psychologist.
The insurance company will choose the physician who will perform the IME. They will notify you of the time and place of the examination. It is important to know that during this examination, there is no doctor-patient confidentiality. Anything you say will make its way into the report that your insurance company is given.
The insurance company will claim that the doctor selected is an independent third party, but this is far from the truth. Independent medical examiners are paid by the insurance companies, so physicians report to them. This makes them biased, even if insurers do not wish for you to view them that way.
What to Expect From an IME
Once you receive notification that the insurance company has set up an IME, it is important to know what to expect. This physician is looking for relevant medical information to include in their report to the insurance company. In addition, the insurance company has likely told the physician what they are looking for specifically.
During this examination, it is important to refrain from giving out too much personal information. Only answer the questions you are asked and answer them honestly without too much conjecture. The examination itself will not take long and the doctor will not prescribe additional medications or treatments during this time.
Preparing for an IME
Before you attend your first IME, it is important to prepare for this examination. Speaking to an experienced workers’ compensation lawyer is a good first step in preparing. Your attorney can walk you through the process and help you prepare for the examination. This alone can maximize your workers’ compensation claim and prevent any unnecessary delays when receiving benefits.
What can you do to prepare for your IME?
- Review your medical history
- Review the details of your work accident
- Speak to eyewitnesses and coworkers
- Reflect on all the harm you suffered and how your injuries affect your daily activities
- Prepare a list of medications you take both prescription and over-the-counter
- Think about how your injuries affect your family and your lifestyle
- Examine how your injuries have impacted your ability to work or may continue to impact your ability to remain employed
On the day of your IME, wear loose clothing and eat a normal breakfast and lunch. BE sure you are comfortable and ready to take the exam. Bring a trusted loved one or witness with you to help record what happens during your examination. This can help should you need to dispute events later down the road.
What Happens in an Independent Medical Exam?
Before the IME even starts, the doctor will already have the necessary medical records and documents they need. In many cases, this will also include a letter written by the insurance company asking the doctor to look into certain issues, such as your diagnosis or medical testing performed.
Remember, their main goal is to give the insurance company the information they need for your case. They are not there to give you a second opinion. Their goal and their loyalties lie with the insurance company.
During the exam, the IME doctor will ask you pertinent questions about your injury, the accident, and any symptoms you have experienced. They will also discuss the treatment you have participated in and the level of pain you are still suffering. The doctor may also conduct a physical exam, as well as other tests that may be useful to their report.
Their goal is to be able to answer the insurance company’s questions in their report and help them learn more about your accident, the injuries you suffered, and the degree of impairment and pain you suffer.
What Does the IME Doctor Look For?
The IME doctor will be looking for any discrepancies in your story, as well as your injuries. They will discuss your prior health history to determine if you had a previous medical condition that might affect your case. They will also look at your lifestyle to help them determine how much of your injuries or illnesses may have been affected by your own choices.
The IME doctor will look at a variety of factors, including:
- Your general appearance
- Medical imaging studies, such as x-rays, MRI reports, or nerve studies
- Physical exam to test for pain and limited range of motion
- Signs of deception or exaggeration
The doctor will often have you perform a series of movements to identify pain, sensitivity, and range of motion. This may include walking, sitting, stretching, bending over, and other types of movements. They use these movements to help them identify whether your injuries would prevent you from returning to work or resuming activities.
Will the IME Affect My Workers’ Compensation Claim?
Many injured workers want to know how the IME will affect their workers’ compensation claim. This is a valid question because the IME is critical to your claim and to collecting the benefits you deserve.
The doctor will write their report and conclusions and send them to the insurance company. The insurance company will then use this report to approve or deny your benefits. As a result, the IME can have a significant impact on your case. That is because IME doctors are often viewed as “experts” in their field and their reports are given significant weight and consideration. Judges in workers’ compensation claims also tend to view IME doctors as more impartial and unbiased. They often value these reports higher than attending and treating family physicians. As such, it can be difficult to discredit or challenge an IME report and the information contained in these reports.
Disputing an IME Report
If you disagree with the IME report, there are ways you can challenge the report. To start, ask for a copy of the report. This can give you the information your doctor will send to the insurance company. If you see that the report is unfair or if there are inaccuracies in the report, you can then take this time to address them.
For example, suppose the IME doctor based their opinion on information that is not correct. You can write to the doctor and the insurance company with that new and correct information to have the medical document changed. The IME doctor can then clarify their report in an addendum. This can significantly impact your case.
However, in order to be truly successful, you will need the help of an experienced Arkansas workers’ compensation lawyer. Your lawyer will need to identify and gather the necessary information to discredit the report. This means investigating the incident further and speaking with your medical team.
If your benefits have been cut off, or you are not getting the help you need, your attorney can file an objection to the IME and schedule a deposition. There are ways to fight IME reports and get the benefits you deserve.
Contact Our Arkansas Workers’ Compensation Lawyers
After an on-the-job accident, it is important to speak to an experienced workers’ compensation lawyer. Your attorney can help you through the independent medical examination and through the workers’ compensation process and appeals. It is essential to speak to us before the IME to ensure that you are appropriately prepared. Our lawyers know how to get you the benefits you deserve and we are ready and willing to fight insurance companies on your behalf.
The team of workers’ compensation lawyers at Rainwater, Holt & Sexton, are here to help. We offer free initial consultations for all injured workers. With six Arkansas office locations — Little Rock, Springdale, Conway, Hot Springs, Bryant, and Jacksonville —our injury lawyers are easily accessible when you need help.