An independent medical examination (IME) is. Note: This page was last updated on February 21, 2023. Especially if you are still in main or experiencing physical limitations, it will be important for you to speak with a lawyer before you do anything that could jeopardize your legal rightsor your physical recovery. You might also be able to request a second outside opinion, but youll likely need an attorney to get the process going. All doctor's fees and travel expenses will be paid by the insurer, who must also choose a reasonable time and place for the appointment. 12 MUST KNOW Facts about Filing for Workers Comp, Workers Compensation for Exposure to Viruses, Harmful Substances, and Dangerous Environments, Seeking Workers Compensation for a Concussion. Insurance companies will often stop paying workers compensation benefits once an IME clears an employee for work as welland this can put injured workers in a very challenging situation. The insurance company calls it a request, but the hard truth is that if you refuse to undergo the IME, your claim will be flatly denied. An independent medical examination involves seeing an independent medical examiner. Make sure to include evidence to prove your claim. 5-Step Disability Evaluation Under Social Security Additionally, if you dont agree with the IME doctor, you might be able to challenge their decision if they made it based on incomplete, incorrect, or outdated information. The IME Doctor Disagrees With My Doctor: What Do I Do? Questions about hiring an attorney? You consent that the funding company you are matched with or a call center may contact you by phone and/or text, even if you are on a Do Not Call Registry. Under the Workers Compensation Act your employer or its insurer can force you to attend one IME per medical specialty per year. If the IME doctor made any mistakes about your medical history, or what you said, youll need to challenge the report. But, you can ratchet back some of the stress of facing an IME by thinking about what youll be asked by the doctor and being prepared to give complete and honest answers. Three weeks ago I just had tendinitis, and my Dr. didnt release me from work. when theres doubt about your workers compensation claim. 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. Or the doctor gave you a completely different disability rating than your doctor. Workers Comp: Settlements for Back Injury, Workers Comp: Settlements for Bulging Disc, Workers Comp: Settlements for Herniated Disc, Workers Comp: Settlements for Ankle Injuries, Workers Comp: Settlements for Brain Injury, Coronavirus (COVID-19) Workers Compensation and Unemployment Information All 50 States, Workers Compensation Deadlines All 50 States, Personal Injury Statute of Limitations All 50 States, Can You See Your Own Doctor on Workers Comp? Some injured workers do not realize the negative impact that the IME report can have on the insurance companies valuation of their cases. Chris has been helping injured Washington State workers for over 40 years. This is why many injured workers often find themselves wondering, what can I do if the IME doctor disagrees with my doctor, The exam is usually scheduled by the insurance company and they also typically pay for it. In most states, you can refuse to have the nurse in the examination room with you while you are seeing the doctor. If you dont like what L&I is doing to you, you must do something about it. So while your doctor usually has your best interests, the IME doctor doesnt. 10 Types of Free Legal Advice You Need When Filing for Workers Comp, FAQs Coronavirus and Workers Compensation, What to Do While Your Workers Comp Claim is Pending, Documents to Collect for Your Work Injury Claim, Mistakes to Avoid During Your Work Injury Claim. He has built a successful law practice by thoroughly educating, honestly helping, and successfully representing workers throughout Washington State. If you are currently represented by an attorney, you should strictly abide by his/her counsel. Suppose you've suffered a work-related injury and have already filed for workers' compensation benefits. Try to get a copy of that letter. Your attorney can also start preparing to dispute the IMEs report (as this will most likely be necessary); and, after the appointment, your attorney can deal with the insurance company on your behalf. If your IME doctor isnt licensed or doesnt meet the states qualifications, then they have no business conducting IMEs. The bottom line is that every case is different, but if you are being asked to go to more than one IME it's at least suspicious and potentially against the law. This could include simple observations or may involve video surveillance. 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 . My lawyer refused to go to this new doctor as they already had established an IME doctor for my case. As a result, lots of insurance company-approved doctors are more likely to treat injuries with pain medication. If you havent been able to dress yourself since the accident, or sometimes have trouble making it to the bathroom in time, you must speak up. console.log("hash::"+hash); You agree these messages may be auto-dialed or pre-recorded, and consent is not a condition of purchase. The insurance company wants to see if a new doctor will agree with the action or course of treatment the workers compensation doctor is recommending or to see if . As [] In cases like this, an experienced workers compensation lawyer like Victor Malca can help you. What should you do? Most states have stringent requirements when it comes to choosing an IME doctor. The insurance company will send copies of your medical records to the IME doctor well before the scheduled exam date, usually along with a cover letter telling the doctor what they want to know about your condition. You will have to balance the cost of the treatment against how much you need it. If you are requested to undergo an independent medical examination (IME) after applying for long-term disability benefits, the purpose of the examination is typically to undervalue or completely discredit your claim. Independent Medical Exam (IME) Doctor - These doctors conduct IMEs on behalf of the insurance company. But if you feel you are being played by the workers comp insurance company, or you arent sure youre getting the benefits you deserve, dont wait to protect your claim. The simple answer is that IME doctors arent always right. Yes, you can. 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. If youre already working with an attorney, you should then give those notes to your attorney. Is It Time to Speak with a Work-Related Injury Lawyer? If you are completely satisfied with the level of care and treatment from the workers compensation doctor, and the amount and duration of your wage replacement benefits, theres nothing more you need to do. Copyright 2005-2022 | All Rights Reserved Worldwide. Categories Independent Medical Examinations With this, its inevitable that the IME doctor will disagree with your treating doctor. That is not "independent." Instead, expect the IME doctor to disagree with the doctors you have hired to provide your medical care. Unfortunately, based on your answers, we will not be able to help you. The insurance company disagrees with your treating physicians medical opinion. Can You Claim Unemployment and Workers Comp at the Same Time? However, if the deficit in both ranges of motion are moderate or higher, and the measures are within 10 degrees of each other, up to 10% may be added to the overall schedule loss of use, not to exceed ankylosis." In the 2018 Guidelines, note Table 5.4 (a), p. 31. While it might be okay for you to return to work, it also might not. Contact us today to schedule a complimentary and free case evaluation and learn how we can help you. Another potential conflict of interest arises when doctors own or have financial connections in the healthcare facilities they are referring you to for diagnostic exams or treatment. They usually send a copy to your doctor with a cover letter asking them to agree or disagree with the IME report: Doctor, if you disagree, write a lengthy report. These tests are expensive and complicate the entire claim. In that case, she could recommend that you be sent for an independent medical exam with a different workers comp insurance company doctor. In Nov, 2009, the work comp carrier wanted me to go to another IME with a new ortho doctor from Madison. Talk to a workers compensation attorney. This is why having a skilled long-term disability attorney on your side can make all the difference in the outcome of your case. Strictly speaking, you do not have to go back to work when an independent medical examiner disagrees with your doctor. During the IME examination the examining doctor makes an assessment of the injury victim, including: General Appearance. behalf if necessary. Most IME doctors don't treat patients. Sometimes, they may even hold more weight than that of your doctor. The process of choosing an IME doctor varies from state to state. Then, L&I or the Self Insurer will take the IME and your doctors concurrence and move your claim toward the IMEs conclusions. What You Should Not Tell Disability Doctors, How To Update Your Social Security Record After Becoming A Citizen. Nothing on this site should be taken as legal advice for any individual Review exactly how the accident happened and be prepared to re-tell the details to the IME doctor. If IME doctors tell you differently, they are wrong. Also, IME doctors do not always have all the treatment records. If L&I requests a legitimate IME, it is extremely important for the injured worker to arrive alert and prepared for the examination. I was seen at the hospital and then told to go to. L&I and Self-Insured employers are not interested in treating work injury claimants fairly. RCW 51.32.110 (3), WAC 296-20-1103, and L&I Claim Adjudication Guidelines. Learn about Permanent Partial Disability Settlements. Or the doctor gave you a completely different disability rating than your doctor. Your claim will change after an Independent Medical Examination. If you need to go to an independent medical exam, your attorney can explain what you need to say, what you should not say, and what you should do once the appointment is over. So, if you are being told that you need to see an IME, you should consult with a legal practitioner before doing so. The doctor will then use this information to determine whether they agree with your personal doctor or not. 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. . His law firm is helpful, honest, and knowledgeable about workers' compensation and personal injury law in the State of Washington. So, if you are wondering, Why does the IME doctor disagree with my doctor?, you are not alone. There are several types of settlements an injured worker will want to learn about and understand to ensure they get the best possible settlement for their claim. careful about your next steps. }, 1000); Do I have recourse after I was kicked off Workers Comp because of an IME? You agree these messages may be auto-dialed or pre-recorded, and consent is not a condition of purchase. But in most cases, its the insurance company that gets to choose the IME doctor. Despite their label, IMEs are not independent. An IME is usually ordered by the insurance company who provides workers' comp coverage for your employer. Stephen Scott, the Aetna Claims Analyst called our office today and said that our client must sign the form or Dr. Demeter won't exam her. 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. At the other end of the spectrum, the employee will be entitled to 6 weeks of benefits for every percentage of impairment that is more than 21%. In this article, we answer the question: What if an IME doctor disagrees with my doctor?. He reported it to his supervisor, and requested to go see the company doctor. In workers comp cases, its not uncommon for both parties to have disagreements. Although most nurses are honest and hard-working, dont forget that the nurse is employed by the insurance company. This medical opinion is sometimes based upon surveillance video obtained by the insurance company through private investigators. 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