Your Own Doctors Opinion vs The IME in Workers Comp Claims

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Many people who file worker’s compensation claims often find that their employer’s insurance company requires that they undergo an Independent Medical Examination (IME), even if they have already been diagnosed or treated by their own doctor. If the Workmens comp independent doctor opinion differs from own doctor what happens then? This is a common question that comes up in many of these claims. In some jurisdictions, the insurance companies who are responsible for wage replacement benefits have the right to dispute the opinions of the claimant’s doctors.

The Purpose of the Independent Medical Exam

Worker’s compensation insurance companies can send the injured employee to a doctor of their choosing, sometimes twice each year. If they refuse or fail to attend the IMD, the insurance company can have the injured worker’s benefits suspended. Some states allow workers to select their own doctor, as long as the Workers’ Compensation Board approves of their selection. The word “independent” may be a misnomer in certain situations, because some of these doctors have a reputation for telling the insurance company what they want, rather than what the injured victim actually requires for treatment. The goal of the insurance company may not be to obtain an impartial review, but rather to try and justify discontinuing benefits.

Conducting Yourself During the Exam

When your benefits are on the line, you should do everything possible to ensure a positive outcome of the exam. Preparation is the key and these are some of the things you need to do to be prepared:

  • Take a witness along with you to the exam—The law says that you have the right to bring a witness with you. Make sure it’s a relative, such as your spouse or parent; otherwise, the doctor can prevent them from attending. It is legal, in most states, to have your witness record the exam, either through audio or video. Try and accomplish this discreetly if possible.
  • Know whom you’re dealing with—This doctor works for your opponent and is not on your side. No matter how friendly or sympathetic they may appear, do not be fooled. Their primary goal is to get your benefits discontinued.
  • Keep your answers brief—The independent medical examiner may be full of questions for you. Confine your answers to a simple “yes” or “no” if possible. Do not elaborate or give more details than necessary. The examiner may ask you about your own doctor’s opinion. Instruct the examiner to look in the file that was provided to him or her. Details about your injury and previous doctor’s opinions will be documented, therefore making it unnecessary for you to answer these questions.
  • Never downplay your pain—The doctor needs to know how the pain you are suffering affects your daily life and the ability to work. You don’t need to overact, as this is not an audition for a reality show. If the doctor’s exam further exacerbates your pain, make sure you tell them in a loud and forceful manner.

Why You Need a Workers’ Compensation Attorney

If there is a disagreement regarding the results of the Independent Medical Examination, your case may be heard by the state’s Industrial Commission or Workers’ Compensation Board. It is extremely important that you have an experienced workers’ compensation attorney to represent you at this hearing. Your lawyer may be able to challenge the independent examiner’s credentials if they are not specialists in your type of injury.

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