“Independent” (or are they “Adverse”!) Medical Examinations

On Behalf of | Jan 29, 2018 | Firm News

Was your worker’s compensation claim just denied by an “independent” medical evaluator? You are not alone.

Following a work injury, the insurance company legally can require the injured worker’s attendance with an independent medical evaluator, or IME. The IME doctor is not the worker’s doctor, and the worker does not have to agree with the doctor. The problem, however, is that many IME doctors disagree with the causation opinion of the treating physician, and then the IME opinion effectively serves as the default legal opinion until the case either goes to court or is settled. That means that the insurance company’s hired doctor can be used to cut off a worker’s benefits-forcing the case into litigation.

If the treating physician disagrees with the IME report, a worker should consult with an attorney to dispute the IME denial. After all, the IME is hired by the insurance company.

A recent in-depth article pointed out the potential for bias by insurance company-hired IMEs: Long-time judge: Some ‘independent’ doctors routinely rule against injured workers. For many in the work comp world, a more appropriate term for these hired doctors is adverse medical examination. Certainly that is not true of all IMEs, but some physicians-especially those who are not actively seeing patients-seem to curry favor with the insurance company by denying a worker’s medical claim.

When the insurance company doctor disputes a claim, the injured worker needs their own treating doctor and their attorney to push back against the IME denial.



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