What Is an IME and How Does It Affect a Workers’ Comp Case?

What’s an IME and why is it important to a workers’ comp case? When you have a work comp case because of a work-related injury or illness, your treating physician decides the treatment you need. In addition, the doctor decides when you can or cannot return to work if you have a permanent disability and to what extent. Most times, your employer would ask you to use a physician they choose.

At other times, you might opt to go with a physician of your choice with your employer’s consent. However, as Baltimore workers’ compensation lawyers, we’ve seen that disputes can arise on the state of your health during the claims process. When this happens, the employer’s insurance carrier would ask you to undergo a medical evaluation with a doctor assumed to be neutral.

This evaluation is known as an independent medical examination (IME). So, you must know what they are and their effect on your work comp claim. Our Baltimore workers’ comp attorneys would render legal advice and represent you if you suffered a work-related injury.

When Do You Need an Independent Medical Examination? 

An IME helps in resolving doubts about your medical condition. Usually, it’s the insurance company that asks for an independent examination. They do this when they disagree with a decision your treating doctor made or the general treatment course. This happens especially when the doctor recommends an expensive procedure or surgery.

Insurance companies also demand an IME to determine the extent of a permanent disability. Asides from insurance providers, the judge or Workers’ Compensation Commissioner might request the independent medical examination to resolve a disputed issue related to your case.

In summary, an IME takes place in Baltimore when:

  • The insurer is unsure of the employee’s injuries
  • The injuries sustained are inconsistent with the mechanism of injury
  • The insurer feels that the extent of the wound is not consistent with the medical treatment provided to date
  • The employer wants the injured employee back at work
  • The employer and their insurer would like any medical treatment provided so far to end
  • The insurer or the employer questions the reasonableness or necessity of any medical bills or treatment
  • The employer or their insurer contests the causal relationship between the accident and the medical treatment or injury

Who Chooses the Doctor for an Independent Medical Examination? 

Ordinarily, an IME is supposed to be an objective assessment of your medical condition. It is supposed to cover the treatment you need and whether you’ll be able to work in the future. However, the objectivity of these results depends on who chooses your doctor.

If the employer’s insurer requests the independent examination, then they’ll likely choose the doctor. Unfortunately, when this happens, it is hard for the doctor to be entirely impartial. This is because insurance companies have doctors on retainers and call on them whenever they need an IME. Thus, these physicians, most often than not, give evaluations that favor insurers.

You can combat these by requesting a different independent evaluation or getting your work comp lawyer involved. Also, an attorney is used to dealing with insurance companies and can detect when they are acting in bad faith. The lawyer would also protect your rights during the entire process.

How Will an Independent Medical Examination Affect Your Work Comp Case? 

After the conclusion of the IME, the doctor will write a report on what they believe your medical condition is. The report will also clarify the disputed issues and answer questions raised by the insurance company. Either you or your lawyer will then receive a copy.

The IME result usually has a significant impact on your workers’ comp case. This is because workers’ compensation judges and commissioners see IME doctors as experts. They also see them as more objective than treating physicians and place tremendous value on their reports.

Thus, the compensation payment you’ll get depends on the report the IME doctor gives. However, if you notice a factual mistake with the report, you should write a statement to the insurer and the doctor. Also, support it with your medical records, and get your workers’ compensation lawyer involved. Your lawyer will protect your interest, file an objection, schedule a deposition to question the doctor, or request another examination.

Let Pinder Plotkin, LLC, Represent You!

When going against insurance companies and your employer, it is best to work with Baltimore’s best workers’ comp attorneys. We will closely monitor the IME process and ensure the result does not favor your employer and their insurer. If it does, we will contest it following due process until we get you what you deserve. Your interest is our priority, so contact us today for a free case review with one of our attorneys.

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