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Workers Comp IME : What Employers and Injured Workers Can Expect

By October 28, 2020 No Comments
workers comp ime
If you are an employee and you get sick or injured in the course of your employment, you’d be qualified to apply for workers’ compensation benefits. At this point, you will be examined by your treating physician who will make an assessment to determine certain issues such as:

  • The medical treatment you need
  • The estimated time you will be able to return to work
  • Whether your injury will lead to permanent disability and to what extent

Any employee who gets sick or injured on the job will go through these processes. These are part of the procedures that are typical to all employees who apply for workers compensation benefits.

But if your employer or its workers’ compensation insurer is having doubts about the treating physician’s findings and decisions, you may be asked to see another physician who is tasked to confirm or deny your treating physician’s findings. This process is called an independent medical examination. The IME workers comp process works to resolve an employer’s or insurer’s doubts about how an injured worker is being treated by his/her treating physician.

Who Performs an IME?

Under normal situations and circumstances, an independent medical examination is performed by a disinterested third party contractor who has the qualifications to conduct medical examinations. These are doctors who are contracted to provide an objective medical evaluation on a specific case. As such, they are not responsible for the long-term treatment of a patient that they are evaluating under the IME.

Why a Company may Require an IME: 

IMEs become useful when there is a dispute that needs to be resolved regarding the cause, gravity and medical treatment of a work-related injury. An IME is necessary especially if liability becomes an issue. 

IMEs are typically requested by an employer or its insurance carrier. One of their main purposes for asking for an IME is to verify or ascertain if an injured employee’s medical condition has something to do with a compensable event. The employer or insurer can use the result of the independent medical examination as basis for their decision to honor or deny the claim.      

With that said, an IME has a huge influence in the approval or denial of a workers’ compensation claim. Employers or their insurers typically seek an IME because they are not quite convinced of the injured worker’s honesty or the treating physician’s diagnosis and treatment recommendations. 

If you are an employer, here’s the most important thing you should know about IME:

  •  Timing is Important

           If you arrange for an IME too soon, there’s a possibility for the IME doctor to declare that he/she needs more time to determine if the               treatment administered by your injured worker’s treating physician is serving its purpose.

           Your failure to request for an IME at the right time could work against you especially if your goal for requesting an IME is to find a                     solid basis for changing the course of the treatment.

Your Choice of an IME Doctor is Very Important

If a workers’ compensation case reaches the point of litigation, a judge can actually disregard IME results if he/she believes that the treating physician’s findings are more sensible. Avoid such situations from taking place by choosing a top quality and highly credible physician who has the capability to back up his opinions with facts.

As an employer, these are some of the most important things you should know about IME workers comp beneficiaries claim when they get sick or sustain injuries on the job. You only have a few reasons to ask for it, but sometimes it would be necessary. It’s a way to make sure that injured workers are getting the right medical treatment. It can also help to ensure the patient’s fast recovery, early return to work, and reduced workers’ compensation cost.   

What Employees should Expect from an Independent Medical Examination

If you are an injured employee getting treatment under workers’ compensation, being asked to get an independent medical examination could be a worrisome experience. 

The findings in an IME can influence and affect your workers’ compensation claim. But since you have to go through it, the best thing you can do is prepare well for it to be able to project the right attitude in order to get a good impression from the IME doctor. Here are some of the most important things you can expect from an independent medical examination:

Things an IME Doctor Looks For

Before conducting a medical examination, an IME doctor will interview you to learn about the history of your accident and your medical condition. At some point, the IME doctor may refer to your medical records that may be relevant to the issue raised by the party requesting the IME (your employer or its insurer). During the examination, the IME doctor observes you and looks for signs related to your injury. These are:

1. Your General Appearance – Aside from conducting an interview and medical examination, the IME doctor will also observe you as you walk towards the examination table, how you stand, and whether you find it easy or difficult to climb onto the examination table. An IME doctor may even take note of your personal hygiene, weight and other elements that may be relevant to your injury or condition.

2. Signs of Deception – This is one of the most important things an IME doctor is on the lookout for. You can expect them to report any sign of exaggeration of symptoms you may have done, regardless of whether you did it intentionally or not.

3. Objective Manifestations of Injury – The doctor will also do a review of all available images of medical exams relevant to your injury. These include x-rays, CT scans, MRI reports, and EMG nerve conduction studies. They do this in an effort to find objective and measurable damage or injury to your body. Additionally, the IME doctor will also assess whether your subjective symptoms of pain are consistent with verifiable manifestations of your injury.

4. Subjective Manifestations of Injury – Subjective manifestations of injury refers to symptoms other people may not know about unless you (the sufferer) let them know. The IME doctor will also want to know this by performing tests that allow him/her to detect subjective indications of pain, sensitivity or discomfort. The IME doctor may test you for subjective manifestations in a lot of ways during the examination to make sure that your claimed pain or point of disability is consistent.

5. Other Contributing Factors – You can expect the IME doctor to inquire about other illnesses or injuries you might have sustained before or after the work-related accident. He/she does this to establish whether or not those ailments or injuries aggravated or impaired the recovery of  the injury which is the subject of your workers’ compensation claim.

In addition to the IME doctor’s inquiry about your other ailments or injuries, he/she may also check your lifestyle to discover other factors such as drinking, overeating, smoking or use of illegal drugs, for these might have contributed to your injury.   

On the day of the Independent medical exam, here’s what you should do:

1. Prepare for Your IME

Get yourself organized a few days prior to the test. This will allow you to get the composure you need to respond to any questions intelligently. Some of the most possible questions are about previous injuries, what caused them, what are their symptoms, and the medications you’re taking to treat or relieve the symptoms.

2. Be Punctual

Take note of the date, time and place of the medical exam. Bear in mind that an IME will take you to an unfamiliar environment. You should arrive early to give yourself time to relax and gather your thoughts.

3. Stay Calm

Remain calm and project a positive attitude. Remember that the IME doctor is doing the examination because someone requested it to become a part of your claim. Hence, it is part of a standard procedure. Don’t take it personally.

4. Be Honest

Honesty is important during an IME. Telling lies about your injury during an examination is unacceptable. Remember, you’re dealing with trained professionals who know a lot of ways to discover that you’re not being truthful.

These are the most important elements you should remember when asked to take a workers comp IME. Remember, the IME doctor performing your medical exam is not your personal physician but a consultant tasked to verify your treating physician’s findings and treatment decisions. Treat him/her professionally. But if you believe that the IME doctor’s report is unfair, you should talk to a lawyer about it as it can certainly affect your workers compensation claim.

Any IME workers comp stakeholders typically require is supposed to be truly independent, factual and fair. It is intended to establish the real cause of a worker’s injury or illness. Hence, it should be treated as an instrument for determining the appropriate treatment and care of injured workers comp beneficiaries.

We are one with employers in your objective to nurture the health and well-being of your prized employees. It is our desire to resolve any doubts you may have regarding your injured workers’ treatment – through an objective and unbiased independent medical examination.

Call us at (866) 532-1929 or visit our website: www.novarenetwork.com 

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