Scheduled For A Workers' Compensation Independent Medical Exam? Read This First

17 May 2018
 Categories: Law, Blog

Are you being sent for an independent medical evaluation by your employer's insurance company due to your workers' compensation claim?

If so, step carefully. There are some things that you should know in advance about how these evaluations work and what to expect.

Realize That They Aren't Really "Independent"

When a workers' comp insurer sends you for one of these exams, they are signaling their doubt about the extent or nature of your injuries. While the doctor is supposed to be unbiased, the reality is that doctors who perform independent medical exams (IMEs) at the behest of insurance companies often make their living that way—some don't even see regular patients. 

That means that they have a significant financial incentive to bias their reports in favor of the insurance company—not the victims of workplace injuries. Otherwise, their lucrative relationship with the insurance company might suddenly disappear. While they probably won't outright lie, expect your condition to be downplayed and the description of your illness or injury to be minimized, at best.

Combat The Insurance Company's Games

The insurance company will often seek to bias the doctor before the IME by sending a letter detailing what they say are your injuries and summarizing your treatment. They may also ask the doctor to answer leading questions designed to give them the information they want to deny or end your benefits.

A good defensive move is to ask for a copy of that letter in advance so that you can correct any inaccuracies. You can also review the letter with your workers' comp attorney and make sure that the questions are appropriate and not designed to pry into areas that aren't relevant.

In addition, prepare for the IME in the following ways:

  1. Go over the sequence of events that led up to your illness or injury. You can expect the doctor to ask in order to see if your condition is really work related.
  2. Get copies of your x-rays, MRIs, and other medical tests, and have them with you when you go so that you can show the doctor the evidence of your condition.
  3. Take a witness with you to the exam. His or her job is to simply note the start and end times of the exam and observe the physician's demeanor. If there's a question about the fairness of the exam later, he or she can give important testimony.

Be polite no matter how the doctor behaves—that will work out in your favor if the issue goes to court.

Be Conscious Of Being Under Observation

Finally, realize that you are on display. IME doctors will have their reception staff observe and report on workers' comp patients in order to find evidence that they aren't as seriously ill or injured as they say. 

For example, imagine that you're claiming that your pain and injuries have caused a significant depression. However, you make pleasant small talk with another patient in the waiting room and laugh politely at a joke. The receptionist can report that to the doctor, and it could end up in your medical file as "proof" that you aren't seriously depressed.

Consider yourself under observation from the moment you leave your home until you return again—especially because insurance companies have been known to have private investigators follow claimants to and from their IME appointments!

For more advice on how to handle the IME, talk to your workers' comp attorney today.