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Getting a physical examination plays a big role in any workers' compensation claim. It helps when resolving disputes with the employer's insurance company.
An independent medical evaluator is a physician who wasn't previously involved in the person's treatment. Their job is to evaluate the patient's medical history and current condition.
Many individuals/entities can ask for an IME, including:
Lawyers
Employers
Insurance companies
Judges, hearing officers, and government agencies
By getting help from an examining physician, people can get an unbiased report of a person's illness, injuries, or impairments. This allows them to make decisions based on facts.
This page covers everything to know about IMEs, including their goal and how they influence legal claims.
Is Getting an Independent Medical Examination Necessary?
There are three main reasons why someone could request an independent medical examination:
They want to get an unbiased report about a person's disability, impairment, or limitations that resulted from the incident.
They want treatment suggestions to help the patient achieve a full recovery.
They want to address liability and causality, as well as potential health risks for the future.
The goals of an IME will vary depending on who requested the report. If it's an insurance company, for example, it may need it to either grant or deny benefits. Employers, on the other hand, could use an IME report to confirm their employee's disability status.
Attorneys may also ask for help from an IME doctor, as the report will help quantify damages that the at-fault party will need to pay their client.
What's the most common case, though? Insurance companies tend to request IMEs when they don't agree with the decisions made by the treating doctor. This is common when said doctor requests expensive procedures. Judges and hearing officers can also ask for an IME report to resolve similar disputes.
Who Chooses the Examining Doctor?
Some people find the term "independent" medical evaluator confusing. Depending on the state, an IME isn't necessarily an independent agent.
In Ohio, either an employer's representative or an insurance company can pick the medical professional responsible for the examination. This creates an issue.
When the insurance company is the one requesting the doctor, it's possible for the patient to question their impartiality. Usually, these doctors receive payments directly from the insurers, and they rely on these companies for referrals. In other words, they have a slight incentive to lower the insurer's costs, resulting in fewer benefits for the person.
It's always better for the patient to get help from an attorney if they get asked to undergo an examination. These professionals will guide their clients throughout the entire process, ensuring their rights are always protected. They can also provide assistance to questions such as What is the Family and medical leave act (FMLA)?
What Happens When Getting Independent Medical Examinations?
IMEs will vary depending on the case. First, the examiner will review the person's medical records and any other documents that go over their treatment.
When insurance companies request an examination to resolve a dispute, they may send a letter to the doctor responsible for the patient's case. They may also ask key questions about the patient's medical condition, including:
Were the person's current symptoms caused by a work-related accident?
Was the person's condition accurately diagnosed?
Does the person need additional testing or treatment for their condition?
Does the person have a permanent disability?
Will the person be able to return to work? What restrictions should they keep in mind if they can?
While the doctor usually reviews the patient's records before the examination, they may also do it after. When this phase is done, they will move on to the examination itself.
Examinations may cover the following areas:
Physical capabilities
Cognitive abilities
Mental health
IMEs aren't only about the physical evaluation. The doctor may also have an interview with the patient. Here, they will ask a few questions about how the injury happened, what the person's medical history is, and how their treatment has gone so far.
When the doctor is done with the examination, they will move on to create a report. Said report will address several things, such as suggesting a medical treatment and answering the questions asked by the insurer (or the person who requested the examination).
How Can an Independent Medical Evaluation Affect a Legal Claim?
IMEs affect many legal claims, including workers' compensation and personal injury cases. The main reason why is that most judges and hearing officers give a lot of weight to these reports.
A judge may consider an IME doctor more "objective" than the patient's original physician. In that case, it may be hard for the person to discredit an IME doctor's opinion, even if it's wrong.
Depending on what the doctor said, the person may get fewer benefits, which may not be enough to cover their treatment. What's the solution in this case?
In some cases, the patient can challenge an IME report. These people (or their lawyers) should always request a copy of the doctor's report. This allows them to review the document and determine if there are any mistakes to point out. For more information, the best workers comp attorneys in Columbus may be able to help.
If, for some reason, the doctor's report is based on incorrect information, the patient's attorney can point it out immediately. They will write a letter to the doctor (or their insurance company) explaining the mistake. It's important to back up this letter with the patient's medical records.
Depending on the case, the person may request an addendum or even a second examination.
Some IME doctors may not comply with this request immediately, though. If this happens, it may be possible that the employer or insurer is using the IME to limit (or get rid of) the patient's benefits.
Working with an attorney will give the patient the best shot at disputing the doctor's claims.
What People Should Know Before Getting a Medical Examination
Preparing for an independent medical examination can make things much easier for everyone, especially the patient. There are three key areas to consider:
Medical Records: Patients should be familiar with everything related to their medical condition and treatment. This information includes prescription medications, medical history, test results, etc.
Limitations: Answering the doctor's questions correctly during an IME will result in an accurate report. The patient must explain why they can't keep working as before and talk about their symptoms, which may include a decreased range of motion, fatigue, or pain.
Transportation and Accommodations: Preparing any accommodations necessary before the examination will make things much smoother for the patient.
Legal Help: It helps to ask a lawyer for advice before taking the examination. These professionals will give the patient advice on how to achieve the best outcome possible.
Something important to point out is that there's usually no expectation of a regular doctor-patient relationship here. What this means is that everything the patient tells the examiner isn't necessarily protected. In other words, the doctor can use the patient's arguments against them while writing the report.
These doctors are hired to create an "unbiased" report of the patient's condition. That means that they will point out any inconsistencies that come up during the interview. Everything that may hurt the patient's case will be taken into account.
There's no "pass or fail" result when it comes to IMEs. The ultimate goal here is to ensure that the report reflects the patient's limitations correctly.
Besides being truthful about impairments, the patient must also avoid exaggerating or downplaying their symptoms. The doctor will always include this in their report and use that to justify the denial of further disability benefits.
In other words, patients must be as cooperative as possible during an examination. Being confrontational during the process will only make things worse for them. On the other hand, the patient should consider the doctor's attitude towards them. Any strange suggestions or behaviors could be enough to discredit the results later.
What If the IME Disagrees with the Doctor's Opinion?
It's possible for the IME report to be the opposite of what the patient's treating doctor said. Of course, if the IME report justifies denying or terminating disability benefits, the insurer will go with it.
Thankfully, patients can still challenge an IME with the help of their lawyer. There are many areas they can target, such as:
The insurer hired a doctor without the experience needed to assess the patient's condition.
The doctor focused on irrelevant information while writing the report.
The doctor downplayed evidence that supports the patient's disability.
The doctor summarized factual findings incorrectly when reviewing the patient's medical records.
Bottom Line
Getting asked to undergo an IME can be a headache for most patients. In many cases, this could result in their benefits getting denied, which will affect their recovery journey.
All people deserve to get a fair and accurate examination. If this isn't the case, they should get help from a legal professional who can fight for them. They can help give insight on questions like What is a modified job?
It's crucial to work with an attorney who understands the state's "Worker's Compensation Act." This ensures the person gets the best chance of getting justice for what happened.
At Larrimer & Larrimer, there's a team of professionals ready to help anyone dealing with an independent medical examination in Ohio. They will help people gather all the evidence necessary to ensure they have a great fighting chance.
Those interested in learning more can schedule a free case evaluation today.
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