What To Know About Independent Medical Examinations

After a workplace injury, the steps you take can define the quality of the outcome of your workers’ compensation claim. One of these important steps is an “independent” medical evaluation (IME), which insurance companies use to determine the extent of your injuries and what kind of compensation they will accept and pay (and what types of disputes and defenses exist moving forward).

At Domer Law, S.C., our Wisconsin lawyers are committed to helping clients recover from their injuries while pursuing the outcomes they deserve in their cases—supporting their treating doctors While trying to protect their best interests, they encourage our clients to know what to do and what to avoid while attending their IMEs.

What Is An Independent Medical Examination (IME)?

An IME is an “independent” medical evaluation performed by a doctor who has not previously treated you and is chosen by the insurance company (and not the injured worker). Under the Wisconsin worker’s compensation law, the insurance company has the right to request an IME (and request it at reasonable intervals in the future). The general purpose of an IME is to provide an unbiased opinion about your medical condition, specifically relating to your workers’ compensation claim. The cynical purpose is that the insurance company uses these as adverse medical examinations to deny claims or dispute the extent of a worker’s disabilities. During an IME, the doctor will assess your injury or illness to determine its cause, severity and the appropriate treatment. This examination helps insurance companies, employers and workers’ compensation judges make informed decisions (or create disputes) about claims.

What Should I Do At An IME?

When attending your IME, the following tips can help protect your best interests. During an IME, you should:

• Show up on time for your appointment: Being late for your IME can mean missing out on the appointment entirely, and the doctor may not get an accurate understanding of your condition by the time you can get to your next appointment.
• Stay truthful about your incident: When the doctor asks about your accident, be sure you describe only the truth of what happened without any embellishments or exaggerations.
• Follow your doctor’s orders: Failing to follow a specified treatment plan can result in accusations that you made your original injuries worse, which can cost you the outcome you deserve.
• Bring an observer: You have the legal right to bring an observer to the appointment, as long as they do not dispute the appointment. This can be your spouse, child, friend, or physician.
• Right to a translator: If you have difficulty speaking or understanding English, you have the right to insist on a translator’s presence.
• Audio recording: You can unobtrusively audio record the appointment, as long as you disclose it to the IME physician beforehand.

These are a few steps anyone should follow in their IME. There are also steps you need to avoid while at your IME.

What To Avoid At Your IME Appointment

When at your appointment, it is important to remember to avoid doing certain things, such as the following:

• Do not argue with the doctor: While it is fine to make your side of the case clear, do not get into a serious argument over anything. If the doctor you are seeing for your IME is not providing you with the service you deserve, remember that you may be able to get a second opinion.
• Do not lie about your condition: Your IME is not a time to underplay how hurt you are. If you think you are experiencing a consequence from your accident, do not keep it to yourself at your IME.
• Do not discuss outside issues with anyone at the IME appointment: Talking about finances, your legal situation or your insurance can come back to haunt you in your workers’ compensation claim.
• Be aware of surveillance: The insurance company and the IME will likely be videotaping you driving to/from the appointment and walking in/out of the appointment setting. Make sure your activities are in line with what you are indicating to your own treating doctors.

When at your IME, it is best to keep your priorities focused on your IME and get through your appointment. If you need more information about any aspect of your case, our experienced workers’ compensation lawyers at Domer Law can offer you legal guidance and advice.

Who Can Request An IME?

Both your employer and their workers’ compensation insurance company can request an IME. This usually happens if there is a dispute or question about the nature and extent of your injury. Sometimes, a workers’ compensation judge might order an IME to get an impartial medical opinion. If you feel that the IME requested by your employer is unfair, consult with a workers’ comp lawyer to discuss your options.

Who Can Perform An IME?

An IME must be conducted by a licensed medical doctor who has not been involved in your treatment. This doctor is usually selected by your employer’s insurance company. The physician is expected to provide an unbiased medical opinion.  In general, certain IMEs have more inherent credibility than others, as some physicians maintain active practices and some only do insurance company IME work.

It is important to note that the IME doctor is not there to treat you- they only evaluate your condition. If you have concerns about the doctor chosen for your IME, speak with an experienced workers’ compensation attorney. Our workers’ comp lawyers at Domer Law can assist you in addressing any concerns that you have and help make sure that you receive a fair evaluation.

Generally, an insurance company must stick with the same IME physician for all IME appointments/reports during the worker’s claim. If an injured worker is asked to see a new, different IME physician, they need to ask for the reason or seek out worker’s compensation counsel.  If there is a substantive change in a worker’s medical condition (for example if an orthopedic injury results in mental health care), the insurance company may be allowed a separate IME that specializes in the related medical treatment.

Where Does The IME Take Place?

The location of the IME can vary. It often takes place in the doctor’s office or clinic that the insurance company designates. Sometimes, you may need to travel a significant distance to attend the IME. However, under Wisconsin workers’ compensation laws, the IME must be performed within 100 miles of the injured worker’s primary residence.  The insurance company must pay for mileage to/from the appointment, as well as payment of missed work hours for the appointment.  If the worker lives out of state, the insurance company and the worker can consult about travel arrangements and payment.

If you have a scheduled IME, it is important to keep all appointments and arrive on time. If the location presents a hardship, consult a workers’ compensation lawyer. An experienced workers’ compensation attorney might be able to help negotiate more convenient arrangements or provide advice on how to handle the situation.

What Happens During The IME?

During the IME, the doctor will review your medical history, including any records related to your injury. Generally, the appointments are very short (5-15 minutes), and it is important for the worker to keep track of the total amount of time the IME doctor spends with them.  The IME might perform a physical examination and may ask you questions about how the injury occurred and how it affects your daily life. The doctor might also conduct diagnostic tests if necessary. It is important to be honest and thorough in your responses. After the examination, the doctor will write a report summarizing their findings.  Unfortunately, there is no time limit dictating when the doctor needs to produce the report after the evaluation.

Why Is The IME Report Important?

The IME report plays a crucial role in your workers’ compensation claim. It provides an “independent” (or adverse) medical opinion about your condition, which can influence the decisions made by the insurance company, your employer and workers’ compensation judges. The report can affect the benefits you receive, including medical treatment and financial compensation. If you disagree with the IME report conclusions (as many workers do), consult with a workers’ compensation lawyer to better understand the report and its impact on your claim.

What Happens If I Disagree With The Findings In An IME?

If you disagree with the IME findings, you have options. First, discuss the report with your workers’ compensation attorney to understand the discrepancies and decide on your next steps. Write up a detailed description of all the findings you disagree with in the report.  Second, present the IME report to your treating physician, and request something in writing on the reasons your treating physician disagrees with the report.  Also, any medical records, documents, photos, or videos referenced in the IME report must be disclosed to the injured worker, so request any of this information that you do not have in your possession.

Unfortunately, under Wisconsin law, the IME report effectively serves as the default opinion for the insurance company.  The only way to overturn the opinion is through settlement or attending a hearing to resolve the dispute.  You need your own medical proof supporting the case in order to dispute the IME findings.

How Often Can the Insurance Company Request an IME?

Worker’s compensation insurance companies are allowed to have IMEs at reasonable intervals—generally, as short as every six months.  Additional IMEs may be requested if there is a substantial change in a worker’s condition (i.e., needs surgery, permanent limitations assessed, or PPD provided).  It can be frustrating to undergo multiple IME evaluations, but the evaluations are needed to get the case to a final conclusion.

Consult A Wisconsin Workers’ Compensation Lawyer For Free

If you are ready to meet with someone to further discuss your workers’ compensation claim, our Milwaukee workers’ compensation lawyers offer free initial consultations. To schedule your free appointment, you can call us at 414-279-2647 or email us by using our online form. We look forward to answering your questions and telling you more about how we can help you with your case.