What Are the Components of an IME? - Independent Medical Examinations for Workers Compensation Claim
Getting injured on the job entitles workers in Tennessee to a workers' compensation claim that will cover all of their medical expenses and lost wages for the duration of their recovery. However, not every situation is that simple.
Sometimes, the employer's insurance company may request that the worker submit to an independent medical examination. This can have a wide range of implications for the employee's workers' compensation claim.
As such, the employee needs to seek the advice of an experienced workers' comp attorney before agreeing to any physical examination. A good lawyer can help workers to understand their rights and obligations regarding independent medical examinations.
With so many years helping workers in Tennessee receive fair compensation from insurance companies, Schuerger Shunnarah Trial Attorneys has what it takes to go to war for its clients. Injured workers can call the law firm and request a free consultation.
What Is an Independent Medical Examination (IME)?
By definition, an independent medical examination (IME) is a physical exam that is conducted by a neutral physician whose job is to determine the extent of the injuries sustained by the worker.
However, in reality, there is nothing "independent" at all about an independent medical examination.
One thing injured workers must remember is that the physician conducting the physical examination has been chosen and is being paid by the insurance company.
As such, their role is not simply to determine the medical condition of the worker, but to help the insurance company either avoid being liable in a workers' compensation claim or at the very least, reduce the settlement amount.
This is why, in most cases, the insurance company will only request an independent medical examination in cases where it does not agree with the worker's doctor.
If the diagnosis requires extensive medical treatment and a lot of time off work, both of which will cost the insurers a lot of money, asking for an independent medical exam is their way of fighting the claim.
However, there are also cases where the workers' compensation judge will request independent medical examinations as a way to resolve a dispute between an injured worker and the insurance company.
Since the doctors hired to examine the injured worker know that it is in their best interest to give a report that is favorable to the insurance company, they are not likely to be fair when evaluating the worker.
As such, while it may be impossible to prove that the insurance company is influencing the outcome of the IME report, workers can protect themselves by seeking legal advice before submitting to the examination or releasing any medical records.
Who Handles the Independent Medical Exam?
Usually, IME is handled by an independent medical examiner, who may be a qualified doctor with experience dealing with occupational injuries.
The key requirement for independent medical examiners is that they be qualified to diagnose the condition or injury that the worker is suffering from.
Evaluation Process for Claims
An injured worker may be asked to submit to an independent medical examination (IME) for a wide range of reasons, such as:
A medical doctor requests an IME as part of litigation
The worker's own attorney requests the IME to strengthen their case
An employer or their insurance company requests the exam because they do not agree with the diagnosis of the worker's doctor
A judge requests an independent medical examination to settle a dispute between the two parties involved in a workers' compensation claim
Details Included in an IME Report
Generally, the factors included in an IME report depend on what the requesting party wants. In other words, if the insurers are paying for the IME, they will likely want the report to focus on the things they feel will add weight to their case, or discredit the injured worker's claims.
However, in most cases, the IME doctor will include the following information in the IME report:
The worker's current health
Possible causes of the injury or illness
Whether maximum medical improvement has been reached
The likelihood that the person is exaggerating any symptoms
The best treatment for the injury/illness, and the likelihood that treatment will work
Any lifestyle factors that may be contributing to the worker's condition
The medical evidence for the various symptoms
What Are the Components of an IME? - Five Key Considerations
Even though the injured worker will know that the IME doctor is being paid by the insurance company, that is no reason to be anxious about going for the independent medical exam. It is important to remember that the purpose of the exam is to simply gather information about the injury.
It might make the experience easier if workers know what IME will comprise. As such, they should consider the following components of an ordinary IME report:
From the moment the worker reaches the waiting room, the IME doctor will keep a close eye on everything they do. The doctor will be on the lookout for any clues the worker's general appearance may give as to the severity of the injuries suffered.
Signs of Deception
An experienced IME doctor will be very good at catching any signs of deception from the way the worker behaves, or how they answer questions. An insurance company may even go as far as checking the worker's social media posts in case, for example, they are engaging in physical activities that they are claiming to be unable to do.
Review of Medical Records
Injured workers should expect the IME doctor to conduct an extensive review of all the medical records associated with their injuries. As such, the doctor will look through X-rays, MRI reports, CT scans, and much more. The aim of this is to determine whether what the worker is claiming is the same as what their medical records show.
A series of tests may be conducted to test if what the worker is saying about, for example, pain and lack of mobility is true. These tests may be done several times so that the doctor can determine whether the claims are consistent.
A Look at Past Medical History
Finally, the IME doctor may dig deep into the worker's medical history, looking for any signs that their current medical condition may be a result of a past injury or illness. Such a revelation would give the insurance company the ammunition it needs to fight the personal injury claim.
Tips to Remember Before an IME
To make the independent medical examination process a little easier for injured workers, here are some useful tips to remember:
They can prepare an outline to help when answering questions from the IME physician conducting the tests
If there is someone available to help drive the worker to the appointment, they should do so
Arriving at least minutes early and dressing neatly is recommended
The workers must remember that from the time they arrive in the parking lot to the time they leave, they will be under observation by the doctor and the rest of the staff
Workers should ask for copies of any forms or documents they are asked to sign
It is best to be straightforward when answering questions, but also only answer what has been asked
Injured workers should be honest about any previous injuries that the IME doctor may want to know about
How Does an IME Impact a Workers Compensation Case?
The IME report can have a huge impact on the outcome of a workers' compensation case, especially if it was requested by the judge to help settle a dispute between the worker and the insurance company. As such, it is important to have a good lawyer available to help challenge the outcome of an IME report.
In cases where the IME report is being used to discredit the injured worker or challenge the requested compensation, an aggressive personal injury attorney can dispute the findings by claiming the following:
The medical history included in the IME is incorrect
Any settlement offers cannot be reduced because the injuries to the worker are more serious than what the IME physical examination shows
The IME doctor who conducted the examination is not qualified to do so
Can Injured Workers Refuse an IME?
If a worker refuses to go for an independent medical examination, the insurance company may stop the benefits that the worker is receiving, and also petition a judge to force the worker to submit to the examination.
As long as the IME is at a reasonable location and time, injured workers are obligated to attend at least twice a year. However, the worker is not obliged to all their medical records. All they need to do is show up at the appointed place and time. Schuerger Shunnarah Trial Attorneys can also answer questions like What if my accident injuries don't show up right away?
After a Work-related Injury, Victims Should Seek Legal Advice
There are so many ways an insurance company may want to use an IME report against an injured worker in a workers' compensation dispute. To have the best chance of walking away with the compensation they deserve, victims of a workplace injury should have a competent lawyer by their side. Schuerger Shunnarah Trial Attorneys is ready to go to war for clients seeking fair compensation for their injuries.