What is an Independent Medical Examination (IME)?
The other side, known as the “defendant,” has requested that their doctor examine you. They have a right to have a doctor of their choice examine you, at their expense. The purpose of this examination is to check your medical condition and the extent of your disability.
This will permit their doctor to evaluate the medical treatment that you have received up to the present time, as well as give the defendant ammunition to oppose your claim. It is not unusual for the defendant’s doctor to disagree with the opinions your doctor has expressed concerning your condition.
What is a petition for independent medical examination?
A petition for an independent medical examination is typically filed by attorneys representing your employer or their workers compensation insurance carrier if you fail to attend an examination that has been scheduled or are refusing to do so. This petition results in a hearing in front of a workers compensation judge. If the judge orders you to attend an examination and you failed to do so, the judge can stop your benefits on that basis.
What is the purpose of an independent medical examination?
An independent medical examination is arranged by your employer or their workers compensation insurance carrier to obtain an opinion from a doctor they select in connection with your workers compensation claim. The examination is purely for legal purposes. The doctor who conducts this evaluation has no patient/physician relationship with you and no obligations to you.
What does the IME stand for?
IME is an abbreviation for “independent medical examination”. This is a term often used in workers compensation cases in Pennsylvania, to describe an examination that is scheduled by an insurance company or self-insured employer in connection with a work injury claim. Interestingly, this phrase does not exist in the Worker’s Compensation Act, which instead refers to an examination with a physician chosen by an employer.
The term Independent Medical Examination (IME) can be misleading. The doctor who conducts this examination is not truly independent. Usually, it is a doctor who regularly conducts examinations on behalf of insurance firms, employers, or their representatives.
How many independent medical examinations may be requested?
With a workers compensation claim, the first IME is a matter of right for the insurance carrier. Any subsequent exams can be allowed if reasonable and necessary. In most instances, the workers compensation judges will allow subsequent examinations no more than every six months, and may limit subsequent examinations if your case is already in litigation.
Likewise, a workers compensation judge could order another examination sooner than six months, if some new development occurred to justify this. After the initial examination, any additional examinations are at the discretion of the workers’ compensation judge. Typically, if at least six months have passed since the last examination, there is usually no reason to object to another examination.
Does the court allow independent medical examinations in nuisance cases?
An independent medical examination is allowed in all cases. The court will not determine if a case is considered “nuisance” until a final decision is issued.
Do I have to attend the examination?
In most situations, you must attend an IME scheduled by the defendant. According to the Workers’ Compensation Act, the defendant has a right to request that you, the injured worker, be examined by an appropriate health care provider or other expert at any time after an injury. If you fail to comply with such a request, without reasonable cause or excuse, you can be denied the right to compensation during the period of your refusal, and possibly future benefits may be forfeited.
What happens at the examination?
At the examination, the defendant’s doctor will ask you questions concerning your past medical history, your present injury, and how you are feeling now. The doctor will also examine you. Additionally, the doctor can require you to undergo tests necessary to determine the extent of your disability. Diagnostic tests such as an MRI or bone scan may be part of the physical examination, provided that the tests are necessary and involve no more than a minimal risk, and are not unreasonably intrusive.
The purpose of the examination is only to help the defendant in its defense of its case. The examination is not intended to provide you with medical treatment and only rarely are you given any medical advice. This examination is a very important part of your case.
Can a physical therapist perform an independent medical examination?
As a healthcare provider, the workers compensation insurance company could technically ask you to see a physical therapist for an independent medical evaluation, but that is not something that ever actually occurs. Usually, the doctors asked to perform these examinations specialized in the type of injury involved, and do these examinations very frequently for the insurance industry.
What can I do to prepare for the examination?
It is necessary that when you attend this examination, you remember to do the following:
- Before the examination, sit down and take time to think about your injuries and medical problems. Also, think about any prior condition you may have had involving the same areas of your body for which you are presently claiming injury. Make a list of all of your complaints concerning the part of your body that is injured.
- It is extremely important that you give the defendant’s doctor a complete and accurate description of your injury and medical history. You should not discuss with the doctor injuries that are not related to this case, unless you are specifically asked.
- Have a friend or spouse accompany you to the examination. It is important that someone, in addition to yourself, be a witness to the events that occur in the doctor’s office. Your friend or spouse, however, may not be permitted to go into the exam room with you. If this is the case, you cannot force the issue. Instead, have them time how long you are in there.
- Be on time for your examination
- Be polite at all times with the doctor and his or her assistants.
- When answering the doctor’s questions, only answer exactly what is asked and nothing more. Do not volunteer any information.
- When asked what injuries you sustained in your claim, it might be helpful if you began with your head and went down your body to your feet, describing fully each and every injury sustained.
- When asked about how your injury or medical problem happened, do not go into great detail. The doctor needs to know what parts of your body were injured, and, in a general way, how the injury occurred. For example, if you injured your back lifting a ten-gallon drum, you can simply tell the doctor that you were doing heavy lifting at work when you hurt your back.
- Do not sign anything you don’t understand. It’s all right, however, to sign medical release authorizations permitting the doctor to obtain copies of your medical records or studies from other medical providers.
- Do not exaggerate or fake your problems. Defendant’s doctors are very good at detecting exaggeration or faking, and if they think you are, this will weaken your case.
- At the same time, do not assume that the doctor will know how badly you really hurt just by examining you. Do not feel ashamed or embarrassed to tell the doctor exactly how you feel and hurt. Tell the doctor in an honest and straightforward manner, without embellishment, about your medical problems.
- The doctor and his staff will be watching you the entire time you are in the doctor’s office and possibly after you leave until you drive away. Therefore, it is important that you do not exaggerate or fake anything at any time.
- If you have pain during the examination, please tell the doctor. Make sure you tell the doctor what parts of your body are still giving you problems. For example, “My lower back still hurts, especially when I sit for longer than half an hour” or “My knee aches when the weather is cold and/or wet.”
- Discuss with your lawyer whether you should take any x-rays, reports, or materials to the doctor. If your lawyer tells you to take x-rays, reports, or other documents to the defendant’s doctor, do so. Do not take any documents, x-rays, or reports to the doctor unless your lawyer approves.
- Do not ask the doctor to give you any opinions about your injury or your case.
- You are being examined by the doctor scheduled to see you. Do not agree to any other examinations.
- You or your witness should take notes during the examination. You should fill out a worksheet about your visit and provide it to your lawyer, and keep it for your records.
Can I audio or video record an independent medical evaluation?
Most IME doctors will not permit this, and the law does not permit you to make an audio or video recording of the examination. The law does allow you to have a healthcare practitioner accompany you to an evaluation. Technically this could be a doctor, but the cost of having a doctor accompany you to an examination of this nature is almost always prohibitive. In some instances, having a nurse attend with you can be arranged at a lower cost, but in the vast majority of cases people submit on their own to the independent medical evaluation.
How much does an independent medical examination cost?
The cost for an independent medical examination or charges for an examination can vary, depending on the specialty of the doctor performing the examination and other factors. Since the examination is arranged by and for the benefit of the employer or insurance carrier in a workers compensation case, they pay the full cost of the examination.
Does Medicare pay for an independent medical examination?
No. These examinations are scheduled on behalf of your employer or their insurance carrier for any workers compensation claim, and are paid for by them. These are not examinations for your benefit. Any insurance you may have, including Medicare, cannot be asked to pay for such an examination.
What happens when the IME doctor agrees with my doctor?
If your workers compensation claim is being contested and the IME doctor agrees with your doctor, in most cases the insurance company will be forced to concede your case, unless there is some other basis for defending. If you are receiving workers compensation benefits already and you are required to attend an IME, and the IME doctor agrees with your doctor, most likely your benefits will continue without any problems, at least at that time. It is rare, however, for an IME doctor to agree 100% with your treating doctor, and it is always advisable to discuss your case with an attorney if you are being asked to attend an IME.
What happens after an IME report is issued?
An IME report is submitted by the doctor to the insurance carrier, and they decide what action if any they may take in connection with it. Whether you or your attorney receives a copy of it will depend on whether your case is in litigation of some sort at that time, or litigation begins because of the report. If the insurance carrier takes no action based upon the report, that is typically a sign that the IME physician agreed with your doctor.
Contact YCL Law with Your Independent Medical Examination (IME) Questions
Learn the truth about independent medical exams (IME’s). If you have any questions concerning the examination or the items mentioned above, please call us at 724-225-9130. You can also fill out our contact form and we will be in touch with you.