Following a workplace injury, your primary physician will conduct a physical examination and recommend a course of treatment. Their findings will play a key role in your workers’ compensation claim.
However, your employer’s insurance company may also request an independent medical examination (IME) to get a second opinion from a doctor of their choosing. If the IME report differs from your initial diagnosis, the insurer may use it as evidence to deny your claim.
Undergoing a workers’ comp IME is a common part of any claims process. But it’s important to know what to expect and how to prepare for it to ensure you get the compensation you deserve.
What is an independent medical examination for workers’ comp?
A workers’ comp IME is supposed to be an objective assessment of your medical condition from an unbiased third party.
The IME physician will evaluate your injuries, level of impairment, and ability to work, and give their own opinion on the treatment you need. Their findings will then be compared to those of your primary care physician.
An IME isn’t the same as regular medical visits or treatments to help you heal, though you may need these as well. Instead, it’s typically requested by your employer, their insurance provider, or their legal counsel.
While you can deny an IME, doing so without an exceptionally good reason will almost certainly result in the denial or termination of your workers’ comp benefits.
Common reasons for IME requests in Kansas and Missouri
There are many legitimate reasons why an IME for workers’ comp might be necessary, such as:
- To verify the severity of your injuries and level of impairment
- To clarify conflicting medical reports
- To evaluate whether your injury is work related or affected by preexisting conditions
- To ensure your treatment recommendations are appropriate
- Because you’ve been non-compliant with treatment, such as missing appointments or not following medical recommendations
However, it’s important to understand that most IME requests are used by your employer’s insurance carrier as an opportunity to dispute your claim for compensation.
This is a very unfortunate abuse of the workers’ comp system, and one that’s not easy to prove. But by researching what to expect from an IME and seeking trusted legal representation, you can prove your right to workers’ comp benefits.
In addition, understanding how workers’ compensation benefits are calculated in Kansas or Missouri can provide valuable insights for navigating the next steps in the process.
How to prepare for an IME appointment
Don’t stress over medical documents
Many claimants worry that they’ll need to provide a full range of medical records and other evidence as part of their IME. But it’s often better if you don’t provide additional documentation.
Your employer’s insurance provider should already have access to your medical records. It’s their responsibility – not yours – to provide their chosen doctor with the relevant documents.
If you provide documentation that the insurer doesn’t, you give their IME doctor a benchmark against which to measure your injuries. Depending on their level of bias toward the insurer, this could actually harm your case.
Dress comfortably and appropriately
The purpose of your workers’ comp IME is to get a secondary diagnosis. So you need to come dressed in a way that makes your area of injury easy to access and examine.
Depending on the location of your injury, you might choose to wear a loose short-sleeve t-shirt or front-button shirt that’s quick to raise or remove. Or you could wear baggy pants, or even shorts if it’s warm enough.
Remember that dressing in a manner that doesn’t reflect your injury could be used as evidence against your claim. For example, a heavy wristwatch on an injured wrist or bringing a backpack with a shoulder injury may suggest your pain isn’t as bad as you say.
Also, be sure to wear or use any prescribed medical equipment such as crutches or a wheelchair. And if you haven’t been prescribed them, don’t use them if you can help it. Following the medical advice of your primary care physician is the best way to show that their diagnosis is true and accurate.
Be concise and honest
You may be tempted to exaggerate your symptoms or injuries to preserve your right to workers’ comp benefits. But any discrepancies between your initial diagnosis and your IME could be used to call your claim into question.
When the IME physician asks about your injuries or prior medical history, answer them simply, directly, and truthfully. Don’t joke or be sarcastic, and certainly don’t lie.
Everything you say during your examination will be recorded and reported to the insurance company. So it’s best not to overshare and risk giving them evidence against your claim.
Know what not to say
During your workers’ comp IME, the doctor will ask about your medical history, injury, and lifestyle activities.
While it’s in your best interest to discuss your injuries honestly, that doesn’t mean you have to answer every question they ask.
No matter how friendly the doctor may seem, always remember they’re not on your side. They’re supposed to be impartial, and it’s their duty to report back to the insurance company.
Don’t discuss any aspect of your workers’ comp claim process. Try not to give too much information that doesn’t seem relevant to the examination, either.
It’s okay to say “I’d rather not discuss that if it’s not relevant to the examination”. And if they ask a question you don’t understand, ask them to rephrase it rather than give an incomplete or incorrect answer.
What happens during an IME appointment?
If the insurer requests an IME, they’ll schedule an in-person examination with their chosen doctor near your home.
Given the importance of your workers’ comp claim, you may expect the IME to be a long and intensive process. But they tend to be very brief and to the point, often lasting just a few minutes.
The insurer should have given your medical records to the IME doctor before your appointment. However, since they intend to make an independent assessment, it’s not unusual to find that they haven’t read them closely.
Most IMEs include two phases: interview and examination.
Your interview will mainly focus on your medical history, current injuries, and treatment plan. The physician will ask questions about your condition and symptoms – which, as we’ve mentioned, you must answer truthfully.
Following that, they may perform a brief medical examination. As well as inspecting your areas of injury, the doctor may ask you to perform certain actions to determine your levels of pain and impairment. Common examples include grip strength and range-of-motion tests.
After your IME, the physician will prepare a report for the insurer. Their findings will then be used to determine the validity of your claim, and in many cases to challenge your right to compensation.
How can IME results affect my workers’ comp claim?
Unfortunately, it’s likely that your IME doctor’s findings will disagree with those of your primary care physician. They might suggest that your level of impairment is much lower than was initially thought, and that you can return to work without delay.
Your employer’s insurer will use these findings as evidence to deny or terminate your workers’ compensation.
This isn’t the end, however. In fact, it’s just a common next step in your claims process.
Despite how it might seem, you shouldn’t be too concerned about the IME doctor’s conclusions. Most judges recognize that insurers try to weigh the results in their favor, and place more emphasis on your initial diagnosis.
Following the IME, your employer’s insurance provider is often required to give you a copy of the doctor’s report. While they’ll use this to deny your claim for compensation, you can actually use it to strengthen your claim instead.
For example, the insurer may have assigned a physician with no specialist experience in your area of injury. Or the doctor may have incorrectly summarized the facts about your injuries, or paid more attention to irrelevant factors.
These mistakes give you a chance to discredit the insurer and convince the courts of your right to compensation. To better understand this process, learn more about workers’ compensation adjudication.
Legal options if you disagree with an IME report
If you disagree with the IME report, you’ll need to make an appeal to the court, or to the Department of Insurance in Kansas or Missouri depending on your state. You’ll also need to provide evidence of your inability to work.
However, winning a workers’ compensation claim alone can be an insurmountable challenge.
Unless you’re a legal expert, you won’t know how to present your evidence or argue your case in the most effective way possible. And insurers have far more strategies they can employ to deny your claim.
If you’re asked to partake in an IME as part of your workers’ comp claim, you should hire a reputable and experienced workers’ comp lawyer in your area right away. With their support, you can better prepare for your IME and build a strong case for your right to compensation.
Keep Reading: When to Hire a Workers’ Comp Lawyer
Defend your right to compensation with Phalen Law
A request for a workers’ comp IME can be a sign that your employer’s insurance company needs to manufacture evidence against your claim. So it’s critical you present the most convincing case possible at this stage to definitively prove your injuries and win your case.
As experts in workers’ compensation, Phalen Law has spent over 50 years’ winning cases like yours throughout Kansas and Missouri. When you hire us as legal representation, you can have confidence that we’ll:
- Provide strong evidence that contradicts the IME’s report
- Demonstrate how the insurance company’s conclusions are false
- Present a powerful case for compensation to the court
Call us now toll-free or fill out our Free Case Evaluation form to give us the details of your workers’ comp claim and arrange your free no-obligation consultation.
