In workers’ compensation claims, and personal injury cases that go to litigation, the insurance company will often schedule you for an IME. That stands for “Independent Medical Examination.”
This explanation will help you understand and prepare for an IME. You can review it several times if you need to. Of course, these instructions have to be very general. Your case may have special issues we need to discuss. Please call me if you have any questions or concerns after reading this explanation.
What is an IME?
The IME is a medical examination by a doctor hired by the insurance company. It is used by the insurer to double check the requests of your treating doctor. Since they are paying for your medical care, they have a legal right to make sure your care is causally related to the accident, and medically necessary to help you recover.
However, it is important to remember that the doctor’s report is also going to be used as evidence in your workers’ comp claim. If there is a dispute about what should be done in your case, this report will be used as evidence against you. (We will, of course, have your treating doctor’s reports as our evidence.)
Two types of IME’s
The insurer will send you to an IME if they want to challenge your claim from the beginning, or if they want to challenge a request made by your treating doctor (like a request for surgery, or an MRI). This post covers those types of examinations.
At the end of your workers’ compensation claim, you will be sent to an IME for a permanent disability rating. If we filed for permanent disability benefits (you will know this), then that is what your IME is for. That is just like the other IME’s – all these instructions still apply – but the exam will be even more quick and summary. The doctor is there just to give you a number. He or she may ask you to do some tests (like walk across the room, touch your toes, checking the range of motion of your arm, etc.) and not much else. Don’t be surprised if this exam takes all of 2 minutes!
Is the IME doctor on my side?
No. This medical exam is not “Independent.” Some attorneys call it a DME – for “Defense Medical Exam.” The exam is done at the specific request of the insurance company opposing your claim. He or she is not your treating doctor, and there is no doctor-patient relationship created during this examination.
This does not necessarily make the examination a total farce. Doctor’s are independent professionals. They are not always going to side with the insurance company just because that is who pays the bill. It depends on what type of doctor they send you to.
The insurance company can choose to send you to a good and reputable doctor. We are blessed to live in an area with some of the finest doctor’s in the world. If that happens, this will be an honest examination and we will seriously consider the reports findings. It may even provide a good second set of eyes on your medical problem. If you are sent to this type of doctor, it may not be a bad thing. And even if we end up having to fight about the results, at least we can be sure it is an honest disagreement.
The other type of doctor is more or less a hack. Some doctor’s will say anything they are paid to say. Sometimes I feel like I could write their report for them before they even see you, because I already know what they are going to say. Obviously, that is not a good thing. That doctor will probably give an opinion that is contrary to what your treating doctor wants to do, and we will probably be filing for a hearing at the Workers’ Compensation Commission to fight about it.
The good news is that the hack doctors are well known – by attorneys and the Commissioners who will decide your case. Their opinions will be given the weight they deserve, which is often very little.
Do I have to go? How far? Can I reschedule?
Yes, you have to go. If you fail to attend, your benefits will be cut off and any future requests will be denied. The Commissioners at the Workers’ Compensation Commission will not be happy with you, either. They expect you to attend and will likely rule against you if we try to go forward to a hearing anyway. Even if the doctor is a hack, and we know what he or she will say, the insurance company has a legal right to send you and get that opinion. The WCC will uphold that right.
And you do have to go to Baltimore if they set your IME up there. I know it is a giant pain in the rear end to drive up to Baltimore for a 5 minute examination. It stinks. But many of the state’s doctor’s are up there, and the Commission will support the insurer’s right to send you to Baltimore. The good news is that you do get paid mileage, so be sure to track your mileage from the time you leave your house to the time you get back.
You can reschedule the IME if it is set for a time you cannot make it. If you need to do this, call my office ASAP so we can do that early. It may not be possible to reschedule at the last minute, and the insurer can try to stick you with a no show fee if you don’t show up without a very good reason.
What do I bring with me?
Theoretically, you don’t have to bring anything. But the letter setting the IME will often ask you to bring films of X-rays, MRI’s, or CT scans. You should have these films with you and you should bring them to the IME. The paper reports are good enough for a lawyer, but the doctor wants to see the actual films.
Frankly, you should have the original films (all of them are on a CD these days) in your possession anyway, so you can show them to future doctors. I urge you to get them from your doctor, or from the facility that did the tests.
How should I prepare?
I want you to spend a little time thinking about your pain and physical limitations, so you can articulate it to the doctor when he or she asks. It is very important that they know your exact symptoms. I don’t want you to “wing it” while in their office and forget to tell them something. You can make some notes to help you explain if you like.
How should I handle myself when I am at the IME?
Be honest and thorough about your pain, symptoms, and physical limitations. Do not exaggerate anything. The doctor will see through that immediately and there will be a line in your report about it. That does not help your case. On the other hand, do not minimize your pain either. Don’t play tough guy and say everything is fine if it is not. This doesn’t allow the doctor to do their job, and it will also hurt your case. Remember these two words – honest & thorough.
However, do not be too chatty with the doctor. Keep this a very businesslike meeting. Stick to the topic at hand. You are not going to talk the doctor into siding with you. They are going to make their report based strictly on the medical evidence. Just because they are pleasant doesn’t mean they are on your side.
What happens after the IME?
After the IME, the doctor will issue a report. Usually, that takes about 30 days. The doctor usually dictates the report, and the office sends out their dictation for typing, and then he reviews it before it goes out, then the assistant gets around to mailing it, etc. You can easily see how this process takes a few weeks. If the doctor is seeing active patients during that time, your IME report is not his or her first priority.
I will get a copy of the report. When I do, I will call you to discuss it and what it means to your case. If you get a notice from the insurer after the IME, call me about it. Our mail often gets delivered after 5:30, and you may see something before I do.
If the report is contrary to your treating doctor’s requests, we will probably file for a hearing before the Workers’ Compensation Commission and we will fight about it there. That is the only way to resolve these disputes over medical care.
Again, call me if you have any questions or concerns. I am happy to talk to you. I provide this explanation so you can be better prepared, and review it multiple times if you need to.
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