Understanding the Independent Medical Examination (IME) and How it Can Impact Your Workers Compensation Case in Virginia

 

You’ve done everything right since the work accident. You filed a claim for benefits with the Virginia Workers Compensation Commission. You chose a doctor from the panel of physicians offered by your employer and its workers comp insurance carrier. And you’ve followed every treatment recommendation made by your treating physician so that you can get back to work after your on the job injury.

 

But now the insurance carrier has requested that you attend an Independent Medical Examination (IME) with a doctor that you’ve never heard of. You have three questions:

 

  • What is an IME?
  • Do I have to go to the IME when the insurance company already got to limit my treatment options by providing a panel?
  • What should I watch for at the IME if I have to attend?

 

This article explains the IME process, your legal rights and obligations, and what you can do to increase the likelihood that the IME helps your claim and doesn’t hurt it. If you have any questions or are looking for legal representation, call, e-mail, or text Corey Pollard for a free consultation. We’ve helped hundreds of injured workers in Virginia get the benefits and lump sum workers comp settlement they deserve.

 

What is an Independent Medical Examination (IME)?

 

An IME is a one-time medical evaluation usually requested by the insurance company when there is a dispute over what medical treatment you need, whether that medical treatment is related to your work injury, or whether you’re entitled to permanent disability benefits. Sometimes your workers comp attorney or the judge presiding over your case may request an IME, but this is less common.

 

Who Chooses the IME Doctor in Virginia?

 

When you hear the word “independent,” you likely think of an objective examination and assessment of your work injury and condition. But this is not always the case.

 

In Virginia workers compensation the insurance company gets to select the IME doctor. And usually the only reason the insurance company requests an IME is because it disagrees with your treating physician’s opinions regarding your treatment, work restrictions, or permanent disability.

 

The insurance company pays the IME doctor. Many doctors who perform IMEs do so regularly and depend on insurance companies for referrals and income. This can lead to biased IME reports that favor the insurance company’s position, not yours.

 

If the insurance company asks you to undergo an IME, we recommend contacting a workers’ comp attorney. He or she can help you prepare for the IME and challenge the IME doctor’s opinions through a number of tools, including obtaining supportive evidence from your treating physician.

 

Do I Have to Attend the IME?

 

As long as you are seeking or receiving workers compensation benefits in Virginia, your employer’s insurance company may force you to attend an IME. Failure to attend the IME may lead to suspension of your benefits unless you have reasonable justification for missing the appointment.

 

There are, however, limitations to these IMEs.

 

First, you must be given reasonable notice and, if appropriate, provided transportation to and from the appointment at the employer’s expense.

 

Second, the examination must take place at a reasonable time and place. The employer and its insurance carrier cannot force you to attend an appointment that is too far from your home. They likewise cannot force you to attend an appointment late at night unless there are special circumstances to justify this.

 

Third, the employer and its carrier are limited to one IME per medical specialty. If they want you to undergo more than one IME per medical specialty, then they are required to gain approval from the Commission.

 

And finally, the insurance company is usually limited to one IME per medical specialty per year without the Commission’s permission.

 

What Happens During the IME?

 

Before the IME the insurance company will send the IME doctor your medical records, diagnostic reports, and other documents it has obtained through discovery. More than likely the insurance company’s defense attorney will send a letter to the doctor telling him or her what issues are disputed and giving suggested answers to questions the insurance company may ask. Usually the insurance company will ask the doctor for his or her opinion regarding whether your current symptoms and work restrictions are related to your work accident, when you reached maximum medical improvement (MMI) or will reach MMI, and whether the treatment rendered and recommended by your treating physician is reasonable, necessary, and related to your work injury.

 

At the beginning of the IME the doctor should explain that no physician-patient relationship exists. Whatever you tell the doctor may find its way into the IME report – especially if it hurts your case and helps the insurance company. The doctor may also include observations in the report. So if the doctor sees you get up and down from the table with no problem and you suffered a back injury, he or she will put that in the report. The judge will then evaluate the inconsistency between your hearing testimony and this observation during your trial.

 

During the exam the doctor may ask you questions about any pre-existing conditions, how your work injury happened, and what treatment you’ve had so far. You should prepare for these questions before the IME.

 

You should also ask the IME doctor whether he or she has any recommendations for your medical care.

 

After the IME the doctor will send the parties a copy of his or her written report and opinions. You should review this report with your attorney and point out things you disagree with.

 

How Will the IME Affect My Virginia Workers’ Comp Case?

 

An IME can play a major role in your workers comp case.

 

Depending on the IME doctor’s reputation, the judge hearing your case may give significant weight to the report. If the report finds that you have reached MMI and are capable of returning to full duty work, you may lose benefits.

 

On the other hand some IME doctors have poor reputations from years of working for insurance companies and issuing reports finding that the injured employee is “faking” it no matter the type of injury. An experienced workers comp attorney will tell you if your IME doctor has a bad reputation with the Commission. In these situations the judge is unlikely to give great weight to the IME.

 

Usually the best way to challenge an IME doctor’s opinions is to have your treating physician review the report and write a report contradicting the opinions. Another way to challenge the IME is to have your attorney depose the IME doctor. This is effective if the IME report shows that the doctor was unfamiliar with your case or made blatant mistakes.

 

Contact an attorney if you’re scheduled for an IME. These are used to limit or suspend your benefits. Through preparation and proactive measures you can fight back against a negative IME.

 

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