In nearly all Pennsylvania workers compensation cases that involve litigation, the injured worker must attend an independent medical examination (IME). In fact, workers compensation insurance carrier are entitled to an IME every six months. Often I have clients ask just what is this examination all about. Here are a few facts regarding IME exams in Pennsylvania workers compensation.
Facts about a Pennsylvania Workers Comp IME Examination
- ‘IME’ stands for ‘independent medical examination’. In reality, the physical examination is not independent, it is paid for by the insurance carrier to give the insurance carrier a medical opinion. A better title for the examination would be an ‘insurance evaluation exam’ or a ‘defense medical examination’ rather than using the word ‘independent’.
- IME examinations serve the purpose of providing a workers compensation insurance carriers medical evidence in a workers compensation claim.
- Insurance carriers are generally permitted to have an IME examination every six months.
- Insurance carriers deliberately pick what doctors they want to perform specific evaluations. Although some doctors are honest, the fact remains that they have been selected by the insurance company to perform this exam because they have given favorable results tot he insurance carrier in the past.
- It is important to understand that IME doctors are not independent and have frequently completed similar examinations for this specific insurance company. These doctors solicit business from the insurance companies by offering to do medical evaluations. They understand that too many unfavorable reports could lead to the insurance carrier seeking a new doctor. They are paid separate fees for the evaluation itelf and then subsequent testimony regarding the evaluation.
- Many times, an IME doctor will issue a report that typically states the injuries sustained are unrelated to accident, are non-work related pre-existing conditions, or that the claimant is ‘symptom exaggerating’.
- It is important for injured workers to understand that the IME doctor is not there to TREAT the work injury, but rather to simply issue a report to the insurance carrier.
With these facts explained, it is important to know that should you received a notice of an independent medical examination for your work injury claim, you should seek an experienced workers compensation lawyer right away. The insurance carrier is not spending money on an examinations for nothing. Often times, it is the beginning of an insurance carrier’s hostile action against your claim.
Here are several reasons an IME may be scheduled
- The insurance carrier may be skeptical of the injured worker’s claim.
- The employer or insurance carrier may believe that the injuries or actual medical treatment provided may not be consistent with the mechanism of injury, in other words, the description of how the injury occurred.
- They could simply be trying to limit the scope of the injury. They may want an IME doctor to limit the injury to a ‘strain/sprain’ rather than a herniated disc or a ‘contusion’ rather than a meniscus tear, etc . . .
- The insurance carrier may be seeking an opinion that medical treatment currently provided to the claimant is not necessary or reasonable, which gives the insurance company a basis to deny medical treatment.
- Perhaps the insurance carrier is simply trying to terminate benefits by getting a full recovery opinion to file a Termination Petition.
- The employer may be simply hostile toward the injured worker.
- In most cases in litigation, such as a claim petition filed by the injured worker, the insurance carrier is contesting the causal relationship between the accident and the medical treatment or an opinion that no work injury in fact occurred at all.
- For long standing injuries, the insurance carrier may be trying to determine the permanency of the work restrictions as a result of the work injury.
- The insurance carrier may be simply harassing the injured worker or positioning the claim for settlement by providing the insurance carrier with a medical opinion that helps them in negotiations.
The most important thing to understand is that if you receive a notice of an IME exam, seek an experience Pennsylvania workers compensation attorney right away. The insurance carrier is paying for the examination and they have a reason to do so. It is usually the beginning of hostile action against your workers compensation case.
If you have been injured at work and have received a notice of an independent medical examination, trust your local Central Pennsylvania workers compensation attorney at Mooney Law. We offer free consultations at any one of our 15 offices in Central Pennsylvania. Call today to schedule an appointment at 833-MOONEYLAW or 717-200-HELP.