Karns & Kerrison Blog

The "Independent" Medical Exam

Posted by Jude Evan Kerrison | Oct 30, 2013 | 0 Comments

Here is the scenario: You have been out on Workers' Comp for 6 months and you have gone through physical therapy and all the other conservative measures that can be taken to rehabilitate your injury. Despite your efforts, there has been no improvement and your Doctor says the only other option is surgery. The Doctor writes to the insurance company for approval and you get a call from the insurance company suggesting that you go to another doctor for a "second opinion". A short time later you get a letter in the mail saying that you have an appointment with a doctor you have never heard of for an "Independent Medical Examination" (IME).

A second opinion seems like a reasonable enough suggestion, who wouldn't want to make absolutely sure that surgery is the best option? However, an IME is quite often a totally different animal. What the insurance company is likely doing in this scenario is attempting to provide itself with a basis to deny your Doctor's request for surgery. The IME Doctor, who is "Independent", is being paid by the insurance company to provide their opinion. The Doctor is not being paid to treat you, but to evaluate you and answer the insurance company's questions. "What questions?" It is likely that you will never know.

Another scenario: You have been out on Workers' Comp for 3 months, your Doctor says that you can't go back to work and you'll be out of work for the foreseeable future. Out of the blue, you get a notice that says you have to submit yourself to an IME with Dr. Smith. You go to the appointment, tell Dr. Smith what happened, tell Dr. Smith what hurts, allow yourself to be examined. Dr. Smith says "thanks very much, you'll get my report in a couple of weeks". You do get that report in a couple of weeks, attached to an Employer's Petition to discontinue your benefits based on Dr. Smith's opinion that you can return to your usual employment without restrictions and that doing so would not be unduly injurious to your health. Also attached is a Notice of Pretrial Conference saying you have to be in Court in a couple of weeks.

The insurance company set the appointment up without your knowledge, got the report back and now they are using it to stop your benefits. So, you are asking can the insurance company do this? If the insurance company schedules an IME, do I have to go? The short answer to both is yes. If you do not attend the IME, your benefits can be suspended and your compensation can be forfeited.

Because you have to attend the IME and submit yourself to the examination, it is vital that you have an experienced attorney can knows the tricks the IME Doctors use and how to overcome the IME Report in Court. The Karns & Kerrison attorneys can't go to the IME with you, but don't go to Court without us.

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