Many doctors chosen by the insurance company have done hundreds and maybe thousands of IME evaluations for workers’ compensation insurance claims. They do not work for the insurance company, but they may try to coerce patients into disclosing information that could discredit their workers’ compensation claim.
When going through an IME appointment, only discuss the current injury and remember that all answers are being recorded for insurance purposes. So, do not lie and do not stretch the truth. An IME doctor has certain legal obligations, and a workers’ compensation attorney at Krasno, Krasno & Onwudinjo can prepare an employee for the examination before the consultation with the doctor.
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What is an IME Doctor?
An IME is an independent medical exam under Pennsylvania Department of Labor & Industry Workers’ Compensation Terms. This is common in Pennsylvania Workers’ Compensation claims. After an employee has been injured, they should always seek their own medical attention. However, if the employee files a claim for their injury claim and reports what their doctor disclosed to them, the employer will likely request an independent medical examination to evaluate the injuries.
The IME will be done by a doctor selected through the insurance company. This doctor will then perform an examination of the employees’ injuries and report their findings. This is an important step in collecting workers’ compensation benefits and lost wages. Before an IME, it is important to discuss your case with an attorney so you know your legal rights and obligations.
Many IME doctors will appear very friendly and conversational. They might ask about your family, hobbies, or weekend plans. This is often a tactic to get you to lower your guard. How it works: The doctor might say, “It’s a beautiful day out. Did you get any gardening done this weekend?” If you have a back injury and say “yes,” they can report that you are capable of physical activity that contradicts your reported pain and limitations. What to do: Be polite and courteous, but keep your answers focused and brief. Do not volunteer information about your social life or physical activities. Stick strictly to discussing your work injury and its direct impact on you. The examination doesn’t start in the exam room; it starts the second you pull into the parking lot. IME doctors and their staff are trained observers. What to do: Be consistent. Your actions and behaviors from the parking lot to the exam room and back should match the physical limitations you have reported. A primary goal of the IME is to find an alternative cause for your pain. The doctor will scour your medical history for anything they can blame. What to do: Be honest if asked about prior injuries, but be clear about how this new work-related injury is different. For example: “Yes, I sprained my ankle in college, but it healed completely and I had no pain or limitations for 20 years before this accident at work.” IME doctors have numerous physical tests designed to see if you are “malingering” or exaggerating your symptoms. What to do: Be completely honest. Give your best effort on all tests, but do not push past your legitimate pain tolerance. When you feel pain, say so calmly and describe it accurately (e.g., “I feel a sharp, stabbing pain in my lower back when I do that”). This is a subtle but powerful tactic where the doctor twists your words in their report to favor the insurance company’s position. How it works: You might say, “I have good days and bad days. On a good day, I can walk for about 15 minutes before the pain is too much.” The IME report might simply state, “The patient reports being able to walk for 15 minutes,” leaving out the crucial context of pain and “good days.” What to do: Speak clearly and concisely. Avoid vague statements. It can be helpful to keep a detailed pain journal leading up to the IME, which can help you provide consistent and specific answers. If your entire exam lasts only 5-10 minutes, it’s a major red flag. What to do: While you cannot force the doctor to be more thorough, your attorney can use the short duration of the exam to challenge the credibility and completeness of the report later on. Make a note of the exact time you enter and leave the exam room. The doctor might ask questions that seem unrelated to your injury, but they are fishing for information they can use against you. The final report is the most powerful tool the IME doctor has. They often write summaries of your medical history that conveniently leave out key findings from your own treating doctors. How it works: The report might highlight a single, minor note from your past while ignoring pages of recent MRI results, specialist reports, and treatment records that confirm your work injury. What to do: This is where having an experienced workers’ compensation attorney is essential. Your lawyer can obtain a copy of the IME report, identify these omissions and inaccuracies, and get a rebuttal opinion from your treating physician to fight back.Trick #1: The “Friendliness” Trap
Trick #2: Surveillance From the Moment You Arrive
Trick #3: Blaming a Pre-Existing Condition
Trick #4: The Exaggeration Test
Trick #5: Misrepresenting Your Statements
Trick #6: The Rushed Examination
Trick #7: Asking Leading or Irrelevant Questions
Trick #8: Writing a Selective or Incomplete Report
What Should I Not Say at IME?
Most importantly, always be consistent with your answers. Do not disclosure information to the IME that you have not already disclosed to other medical professionals. It may be helpful to prepare an outline to ensure consistent answers.
Never discuss settlement case values with the doctor. It is best to never bring up the workers’ compensation claim altogether. Anything stated in the IME will be recorded and reported to the insurance company and employer.
If you do not know the answer to a question, state you do not know or ask for the question to be reworded. Never make up an answer to a question.
It may sound good to exaggerate symptoms because you think it could strengthen a claim, but do not exaggerate the symptoms. The doctor will report that they believe the patient to be exaggerating their symptoms and this will quickly result in a denied claim.
Do not bring up prior injuries or symptoms. Only discuss the injuries you are there for but do not withhold information about those injuries.
What Questions Are Asked During an IME?
The IME will be typical, similar to any other medical evaluation. The doctors are here to diagnose and potentially treat the injuries. It is important to answer all questions honestly. Below are some of the most commonly asked questions during an IME appointment:
- How did the injury occur?
- What symptoms are you having?
- On a scale of 1 to 10, what is your pain level?
- Does the pain worsen when you do certain tasks or activities?
- Has this condition occurred in the past?
- Did you receive treatment for this injury?
- What medical treatments are you currently receiving?
- Are there any physical or mental limitations from the injury?
- What is a typical day like for you?
There are other questions an IME doctor may ask, but the root of his questions will be to determine what caused the injury, how serious the injury is, and what limitations the injury poses on the victim. Additionally, another point of the examination will be to see if the injury requires ongoing medical treatment.
It is important to be honest with each answer. Do not over-elaborate when answering the question. Be clear and concise. Never offer too much information. If the doctor needs you to explain something further, they will ask, but don’t voluntarily disclose anything that is not directly asked.
What Do I wear to IME?
Wear appropriate clothing for a typical doctor’s examination. Depending on the injury, the doctor may ask you to switch to a medical gown for the examination.
Wear clothes and shoes that suit your injury. If you have an ankle injury, it may not be wise to show up to the IME appointment in a pair of high heels. Wear clothes and shoes that match your injury.
Also, if you received medical attention for an injury and were told to wear a sling, use crutches, or wear a brace, then make sure to wear or use the prescribed medical equipment. However, if you were not told to use crutches, then do not bring your own crutches to the appointment to try to make the injury appear worse than it is.
FAQ
Contacting an Attorney
An IME appointment should be like any other doctor’s appointment, and it should not be a point of stress or contention for the employee. However, it can be understandably worrisome if workers’ compensation benefits are on the line.
The workers’ compensation lawyers at Krasno, Krasno & Onwudinjo can help prepare you for your appointment and disclose all legal obligations for the insurance provider, employer, employee, and doctor.
Email or call us at (844) 243-4843 to start your initial consultation with a trusted Pennsylvania workers’ compensation attorney.
