As if getting hurt on the job and submitting a workers’ compensation claim were not stressful enough, insurance companies may insist that the injury be diagnosed during an independent medical examination, usually referred to as an IME. Many employees are surprised by this request, since they have already been to their own doctors for analysis and treatment. Plus, they may already have received workers’ compensation for a while without issues.
However, the insurance company has the right to get a third-party opinion by a physician of their choice about every six months, as long as they do not violate the workers’ rights.
What Every Injured Worker Should Understand About an IME
What is the problem with getting an IME? The issue is that the results of the IME will determine whether the insurance carrier approves or denies the workers’ compensation claim. And insurance companies are not in the business of keeping pricey claims going. Doctors who perform IMEs are not exactly objective. They are paid for by the insurance carrier, which means it is in their best interest to help the insurer save money.
For instance, if a worker is hurt while performing regular work duties, and has completed the required 90 days’ treatment by the employer’s preferred physician, she may go to her family doctor. The family doctor examines her and rules that she has a certain condition, needs physical therapy, requires surgery, and so on. Although this sounds like an airtight case for a workers’ compensation claim until she gets better, the examiner at the IME may come to a completely different conclusion. In that case, the insurance will likely stop the claim despite what the family physician determined.
Not all IMEs end up this way. Some IME doctors echo what the worker’s personal physician said. But friction happens, which is when workers should immediately contact a workers’ compensation attorney to discuss their options.
Can an Employee Say No to an IME?
An IME is framed as a request by the insurance company. This gives the impression that it is something the worker can decide to do or not. And workers do have the option of saying no. If they do, their claims are almost always going to be denied or suspended if payments have already been made.
Knowing this, workers should never instantly tell an insurance company that they will refuse the IME. Instead, they should talk to their work injury lawyer.
Preparing for an IME
In addition to discussing the situation with a knowledgeable attorney, all employees asked to undergo an IME should prepare for the short exam right down to who will attend. Witnesses such as family members and close friends can come to the IME to jot down points and observations. These could be helpful later. If nothing else, having a friendly presence at the IME takes some of the stress out of the experience.
Other good practices are to role play questions and answers about the accident in great detail. Over time, memories can fade. The IME is the last place to forget to include an important event or detail.
Philadelphia Workers’ Compensation Attorneys at Larry Pitt & Associates, P.C. Hold Insurers Accountable
No injured employee in Pennsylvania should feel alone when facing the potential loss of workers’ compensation because of an IME. If you are in the Philadelphia area and have been asked to set up an IME, please contact a Philadelphia workers’ compensation attorney at Larry Pitt & Associates, P.C. by calling 888-PITT-LAW or complete an online contact form.
We offer free consultations to injured workers in Berks County, Bucks County, Chester County, Delaware County, Montgomery County, Philadelphia County and throughout Pennsylvania, including those in the communities of Abington, Ambler, Ardmore, Bala Cynwyd, Bensalem, Clifton Heights, Crum Lynne, Darby, Downingtown, Doylestown, Drexel Hill, Essington, Folcroft, Glenolden, Haverford, Havertown, Holmes, Kutztown, Lansdowne, Media, Merion Station, Morton, Narberth, Norristown, Norwood, Philadelphia, Prospect Park, Quakertown, Reading, Roxborough, Sharon Hill, Upper Darby, West Chester and Wynnewood.