Independent Medical Examinations (IMEs) & Workers’ Compensation Claims
When employees are injured at work, they typically go to their usual treating doctor who will make decisions about the course of medical action, and whether returning to work is an option.
However, there sometimes can be disputes in a workers’ compensation case, and your employer’s insurance company may ask that an independent medical examination or IME be made.
This will include going to another doctor who is deemed neutral for a medical evaluation. This also usually involves a thorough review of the injured workers’ medical records.
This independent medical examination can play a large role in the outcome of your workers’ comp claim. If the IME doctor disagrees with your doctor’s opinion or of your medical condition, your workers’ compensation benefits can be affected. Having an experienced workers’ compensation lawyer guide you through this process can be very beneficial in determining your rights with practical legal advice.
But regardless, it’s important to know the IME process and what is expected from you. We’ll cover all of that in detail below.
What is an Independent Medical Examination?
When workers are injured on the job, their employers can require them to attend an independent medical examination. Typically, before these examinations are conducted, the doctor reviews the medical records submitted by the injured employee to his or her employer, which usually includes diagnostic imaging and lab tests.
Once an appointment has been scheduled, the injured worker will undergo a physical exam and the physician will ask him or her a series of questions regarding the injury and treatment.
The doctor can also recommend other tests and procedures, as long as they involve only a minimal risk and are not unreasonably intrusive. Think of if it as the insurance company getting a “second opinion” of the injury.
Once the exam is complete, the IME doctor will draft a report addressing the following issues:
- Whether the workplace injury is consistent with injuries usually sustained in the type of accident in question
- Whether the employee’s symptoms are related to the work accident
- Whether the treatment recommended by the employee’s physician is appropriate and necessary
- The severity of the injury and the level of pain suffered by the employee
- The degree of the employee’s impairment or disability
- The physical or mental limitations faced by the employee as a result of the injury
- Whether the employee has reached maximum medical improvement, which means that he or she is not expected to make further progress, even with additional treatment.
The length of time that it takes for a doctor to complete an IME report depends on the severity of the injury and the complexity of the case. As a result, a doctor’s report could take anywhere from a few days to a few weeks to be issued.
Generally, patients do not need to do anything to prepare for their exam, although they may be required to bring their x-rays or MRI results, as well as note any pre-existing conditions.
Once the exam is completed, employees are not required to continue seeing that doctor for further treatment. Instead, injured workers will continue meeting with their treating physician, although in some cases, an injured employee may choose to pursue the treatment recommended by the IME physician over their own doctor.
Am I Required to Attend an IME by Workers’ Comp law?
PA workers’ compensation law states that employers have the right to require that injured workers be evaluated by a physician of their own choosing at any time after a workplace accident. Because attendance is mandated by state law, employers are allowed to stop issuing benefits to an injured worker if he or she fails to attend the examination without justification.
These benefits can be withheld for as long as the employee refuses to attend the examination. Furthermore, once an employee has refused to submit to an examination, a workers’ compensation judge may order the employee to undergo the examination at a time and place that he or she chooses.
Even after an employee has undergone an IME, he or she can be ordered by the judge to submit him or herself to further physical examination if the judge deems it reasonable and necessary.
Employers are also required to issue injured workers a travel expenses check to cover the mileage to and from the IME appointment and must make sure that the check is sent prior to the actual date of the exam. Employers can also be required to compensate the injured party for lost wages incurred as a result of attending the IME.
Finally, employees are allowed to have a health care provider of their own choice to participate in the IME, although the injured parties will be required to pay the doctor out of their own pocket.
When are IMEs Conducted?
Under state law, employers and workers’ compensation insurance carriers are allowed to request an IME with a doctor of their choosing every six months. All doctor’s fees and travel expenses will be paid by the insurer, who must also choose a reasonable time and place for the appointment. Patients are also allowed to ask a friend or relative to accompany them, although they are not allowed to record or tape the exam without the doctor’s permission.
Why Independent Medical Examinations are Important for Workers’ Compensation
IME reports carry a substantial amount of legal weight, as they are often used as evidence at subsequent workers’ compensation hearings to establish an employee’s degree of permanent disability or how much he or she should receive in benefits.
However, if the physician is tasked with discovering an employee’s permanent impairment rating, he or she must be:
- Licensed in the state of Pennsylvania
- Certified by a board that has been approved by the American Board of Medical Specialities or its osteopathic equivalent
- In an active clinical practice for at least 20 hours per week
Only physicians who satisfy these criteria are considered qualified to decide an injured employee’s impairment rating. Because these types of exams can have such a significant impact on an injured worker’s case, it is critical for those who have suffered a work injury to speak with an experienced workers’ comp attorney before attending the appointment.
Have Questions About Independent Medical Examinations?
Pennsylvania’s workers’ compensation laws are complex, so being injured at work is not only painful but can also leave employees who have suffered a workplace accident unsure of their next steps.
Having the advice of a dedicated attorney can make all the difference in the outcome of a case, especially for employees who are severely injured, so if you were hurt at work, please contact Krasno Krasno & Onwudinjo by calling (844) 243-4846 to speak with an experienced work injury lawyer about your own workers’ compensation claim and potential benefits.