If an independent medical examiner says that you are ready to go back to work but you are concerned this might not actually be the case, there are some steps you should try to take as soon as possible. In these situations, the Department of Labor and Industries (L&I) will attempt to pound the final nail in the coffin, using an Independent Medical Examination (IME), to end the injured workers claim. We understand that being scheduled for an IME is stressful and can potentially jeopardize your claim. Plaintiffs should assume that any staff members present at the doctor's office . For additional information concerning the amended law, see. Your use of this site does NOT create an attorney-client relationship. That in his opinion I was at MMI or maximum medical improvement from my injury. After a specified time from your claim filing, youll be permitted to have an evaluation and treatment from a physician you choose, whether on the insurance companys approved list or not. You have NO right to confidentiality with this medical exam. Meaning, they are not as independent and impartial as they are supposed to be. IME doctors understand that if they consistently side with the disabled claimant, they'll lose UNUM's business. An IME is supposed to be an objective assessment of your medical condition, including what treatment you need, whether you have a permanent impairment and to what degree, and your ability to work in the future. This is a doctor that is different to your normal treating practitioner. Theoretically, they should be. An IME is an examination scheduled by the Indiana Work Comp Board, and this report will be very important to your case. The IME doctor will review your doctor's records and any objective medical records including x-rays, CT scans, MRI reports or anything similar. Doctors have various reasons for deciding to work for an insurance company, but like most people in the workforce, their goal is a paycheck. My husband felt a sudden snap in his arm while working. Why Is an Independent Medical Exam Being Scheduled? Virtually all state regulations permit you to be treated by your own doctor, but your claim is highly dependent on the medical opinion of the doctor from the insurance companys approved list. He specializes in representing injured workers on compensation benefit cases and disabled individuals claiming lost social security disability benefits. Then, L&I or the Self Insurer will take the IME and your doctors concurrence and move your claim toward the IMEs conclusions. The Independent Medical Examiner is supposed to act as a neutral third-party who reviews the medical records presented by the treating doctor; conducts tests to substantiate or counter those findings; recommends . Disability insurance companies will often rely on either an Independent Medical Exam (IME) or an External Medical File review without examination in order to deny a long term disability claim. The physician treating you has seen you several times, which means they should better understand your injuries. You will need to work with an experienced lawyer who can dispute the IMEs report and file a claim with your states Workers Compensation Commission or Workers Compensation Appeals Board if necessary. With this, its inevitable that the IME doctor will disagree with your treating doctor. Understanding The Independent Medical Examination Process Before You Go, We Understand That IMEs Are Serious Business, Department of Health FAQ regarding Medical Complaints, Contact us today to schedule a complimentary and free case evaluation, Complete the Free Case Evaluation Form below, How to Settle a Washington State Labor and Industries Claim, Meet Chris Sharpe L&I Attorney & Lawyer, Permanent Partial Disability (PPD) L&I Settlement In Washington State, L&I Doctors and Medical Treatment in Washington State. By submitting, you agree to the Terms & Conditions. But in most cases, its the insurance company that gets to choose the IME doctor. This will help them determine if there are any "objective" signs of an injury related to your workplace accident. This same insurance company pays them, so it is common for an IME doctor to disagree with your doctor or the doctor providing care for your workers' comp injury. But that doesnt mean you cant challenge their opinion. While each state has its own rules and regulations regarding workers comp claims, every state mandates that injured workers must be evaluated and diagnosed by a medical professional approved by the employers insurance company. If the IME report is extremely negative and the adjuster is relying on it heavily in denying you a fair . Your health should come first. If you cant help yourself, contact a lawyer to see if they will help you. To make a decision regarding claim allowance or reopening. Because of their financial interests, some doctors may order unnecessary or questionable tests or medical treatments hoping the insurance company will pay for them. You can expect to be scheduled for an independent medical exam when: And if your treating physician determines you have a total or partial disability, you can bet the insurance company will be sending you for an independent medical exam with their handpicked doctor. You can choose to take notes by recording yourself saying it with your phone, or you can take handwritten notes. Some states also require that the medical institutions they work for must be HIPAA compliant. The doctor will then use this information to determine whether they agree with your personal doctor or not. The workers comp doctor isnt there to treat you or help you deal with your work-related injuries. The authority for second opinion medical examinations is found at 5 U.S.C. FL They wont be allowed to speak but ask them to take notes. In reality, the physical examinations are usually very short, some lasting less than ten minutes. Many dont keep up with the latest medical literature, pursue continuing medical education, or stay current in the latest medical technology. However, whether your IME is truly objective may depend, in part, on how the doctor is selected. You will know that you have taken important steps to get your claim moving in the right direction. var anchor_id = jQuery(this).attr("href").split("#")[1]; Your attending physician will be asked by L&I to agree with the IME. I am still in a lot of pain because my. I was lifting a. The nurse will report anything you say or do to the insurance company with no regard for your personal privacy. Even when doctors would normally recommend those diagnostic or therapeutic services, in workers comp cases, they wont mention it to the injured worker. Underscoring this view is the seminal case medical malpractice case in Maryland on this issue is Hoover v. Williamson, 236 Md. In Nov, 2009, the work comp carrier wanted me to go to another IME with a new ortho doctor from Madison. It is NOT formal legal advice. Workers comp refuses to order MRI for elbow injury? } I am a restaurant manager for a very busy chain restaurant. The IME doctor will be looking for inconsistencies in your story, so dont let anyone rush you. Injured on the job? As a result, lots of insurance company-approved doctors are more likely to treat injuries with pain medication. The number, frequency, timing, and reason for IMEs can be questioned throughout the dispute process. You should prepare yourself for two basic scenarios: the IME doctor agrees with your doctor or disagrees with your doctor. Getting a second (and sometimes third) medical opinion can help support your claim. An independent medical examination (IME) is usually requested when theres doubt about your workers compensation claim. state agency. Forced to go back full time on light duty, but still have pain? What To Do Before, During and After an IME, IME Doctors Won't Look Out For Your Interests. While it might be okay for you to return to work, it also might not. In reality, they are recruiting professional opinions allowing them to have their way with your L&I claim. Youll be observed from the time you arrive at the IME location. An IME doctor frequently bases his or her findings on what is often a very brief visit with a patient. Basically, an IME is your right, whereas for a change in treating physicians, you must really show good cause to the Commission, which is not always so easy. The doctor-patient relationship with an IME physician is all about your workers comp claim. My lawyer refused to go to this new doctor as they already had established an IME doctor for my case. Researchers discovered that there are over 4.5 million workplace injuries every year, and workers' compensation claims payouts totaled some $62 billion in 2017 a staggering amount of money. An Independent Medical Exam (IME) is an opportunity for the employer (really the employers workers compensation insurance company) to have you examined by a doctor of their choosing. Our Confidentiality Pledge The information you give us is private and confidential. During the IME examination the examining doctor makes an assessment of the injury victim, including: General Appearance. It is your choice. Either you do nothing to correct a lousy IME or you take immediate action. Their opinions are heavily biased, and many already believe you arent injured before they even begin your examination. Have a personal injury caused by someone else? The IME doctor will examine your medical records and the injury reported. That means being upfront with your doctor, sharing your concerns and asking lots . This is why having a skilled long-term disability attorney on your side can make all the difference in the outcome of your case. The trial court agreed, but the reviewing court reversed, finding the decision "erroneous." (Carpenter, 141 Cal.App.4th at 272.) The IME believes that the depression did not develop secondary to your physical injury, but your treating doctor believes that it did. Read: How to Find a Work Injury Lawyer Near Me. Try to get a copy of that letter. SAVE YOUR RECEIPTS!!! The state agency will review the doctor's report along with all of the other The insurance company nurse may demand to be in the room when your doctor is examining or treating you and wont hesitate to challenge your doctors opinion. The doctor will send a report of the exam or test to the state agency. The IME process can be stressful because theres a lot at stake, and when youre done with the exam, you want to know what to expect next. 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