Boston Worker’s Ccompensation and Injury Blog

What is an Independent Medical Examination (IME)? Must I Consent to an IME?

If you have been injured, chances are you will be asked to submit to what is known as an Independent Medical Examination (or IME). The purpose of the IME is for a doctor chosen by the worker’s compensation insurance company to determine the severity of your injuries and the prognosis for your recovery.

Purportedly, the examination by the physician will be “independent.” Physicians, of course, are trained to be scientific, and thus their examination and conclusions should not be impacted whatsoever by how much the worker’s compensation carrier may pay, or the interest of the worker’s compensation company in seeking to minimize their own damages.

The reality, however, is much further from this ideal.

Physicians who work for worker’s compensation insurance companies will be under pressure to provide an opinion that favors the insurance company who hired them in the first place (particularly if they wish to get future work from such company). For instance, if a physician correctly provides an opinion as to the true severity of an injury which is highly unfavorable to the insurance company, it may well be that the physician will not be consulted for future cases. If the physician rarely conducts independent medical evaluations for worker’s compensation insurance companies, such loss of work may not be of concern; however, for physicians that do conduct significant IME work for worker’s compensation companies, being “cut off” from the list of IME consultants could have a significant financial impact for the physician.

Do I Have to Agree to an IME?

The short answer is “yes.” Under the law, if you file a claim for worker’s compensation benefits, you must submit to a reasonable request by the worker’s compensation insurance carrier to be examined by a physician of their choice. This does not mean that you cannot have your own physician for treatment purposes.

How Much Weight Does the IME Physician Have in a Hearing for Benefits?

At a hearing to determine the benefits to which you may be entitled, I will be introducing evidence from your treating physician concerning the severity of your injury, the prognosis for recovery, and your work limitations.  The insurance company will also be introducing their evidence from their independent medical examination physician who, as noted above, will likely have an opinion that is more favorable to the insurance carrier.

It will then be up to the administrative hearing officer to determine worker’s compensation benefits and related matters, which will be influenced by which evidence is more believable. In most circumstances, the evidence and opinion of the treating physician will usually be more credible than the IME physician, as the treating physician will have more experience in treating the injured worker (often over a number of office visits) than the IME physician (like we may have seen the injured worker only one time). Plus, as also noted above, the IME physician may be seen as having a built-in bias in favor of the insurance company that hired him or her.

Protecting Your Interests

If you’ve been injured, it is critical that you retain an experienced worker’s compensation lawyer to protect your interests against insurance companies and their experts, who will want to minimize the value of your claim and the benefits to which you are entitled. Please contact me for a free consultation and to learn how I and my office can help protect you in seeking the amount of benefits to which you are entitled to receive.

 

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