Workers compensation is a good program for many workers when they are injured on the job and need immediate medical attention. In addition, benefits also include wage replacement when the condition exists beyond seven consecutive days. These two allowances alone are often enough to help the injured worker along while they focus on rehab. However, there can still be problems along the way.
A primary problem many injured victims face is when workers comp insurance providers want what they term as an “independent medical examination” diagnosis from a third-party doctor who is to assess the injury severity as proposed by the injured worker and the initial medical treatment professionals. Requests for further medical evaluation are not necessarily an immediate response, but an independent medical examination appointment could also come at any time within the period of an injury rehabilitation when long-term diagnosis is not favorable for a complete recovery.
And of course, it can further delay a claim approval. Here are a few things to consider when an independent medical examination has been requested.
Who chooses the doctor?
The specific IME physician is typically selected by the workers compensation insurance provider. In addition, these medical professionals are not always specialists in the particular medical field that covers the work injury. The doctors are often semi-retired and work directly for one or more insurance companies on multiple cases. They are paid to provide results that the insurance company can use in building a defense against the case for either denial or a claim value reduction when offering a settlement.
It is always very important to be careful when talking to the doctor because they can and will provide testimony for the insurance company if needed. While they may seem cordial in some instances, they are not there to help. They are essentially an insurance company employee helping them build a defense for not paying the claim. However, depending on state law, the injured claimant can also request a third-party medical opinion as well when insurance companies or employers mandate the first evaluation be conducted by a specific doctor of their choosing.
This is not unusual with cases where the employer has not yet contested the case, but sent the injured employee to the company doctor. Employers and insurance providers often begin this process immediately when they can control the chain of events from the very beginning immediately after the injury occurs.
All cases are unique
A third-party physical examination is not necessarily a red flag in all cases, but it is an indication of how difficult the insurance company may be when a case is being settled. The material case facts matter significantly, and especially if there is an issue of liability for negligence by the employer.
Most typical workers comp cases where an injury is not serious and the worker will return to work in a short time frame will not include an IME doctor appointment, but serious long-term cases or claims for an injury being filed retroactively could generate a demand for further medical evaluation.
Examples of these claims can include back injuries occurring as a result of long-term physical labor as well as carpel tunnel syndrome for overuse of the hands in certain manufacturing positions. Lung and skin based injuries for long-term exposure to chemicals are also examples of work injuries that take years to manifest.
If the injury is retroactive in any form, expect an appointment with an IME doctor scheduled by the insurance provider or employer in the case of a personal injury lawsuit.
What to expect in the examination process
The examination procedure will be based on the type of injury being claimed. An initial workers compensation claim will identify the injury to one or more specific parts or functions of the body. Each diagnosed issue that is an element of the injury claim will be reassessed regarding seriousness and responsiveness of the body, which in turn will be used to craft a reevaluation of the medical condition.
The findings by the IME doctor will also be included in the medical records as an IME report and used to support the injury claim denial defense or as leverage in negotiating a final settlement.
How the IME report can affect a case
The primary purpose of the independent medical exam is developing an argument regarding particulars of the injury. Any evidence of prior existence will be highlighted, but the extent of injury will also be questioned as well.
Insurance companies are well-known for claiming injuries are not as serious as indicated, and any testing will be directed at what functions the injured claimant can still perform. Also included could be claims that certain medical treatment does not follow established medical standards or guidelines that can include being unnecessary options in repairing the reported injuries.
It is essential to have an experienced workers comp injury law firm representing any case where a so-called IME report is requested because the findings are always used to the advantage of the provider and the employer when they demand the exam.
How an Attorney can use the IME information
While the information gleaned from a requested IME can be used in crafting a defense against an injury claim, sometimes the information can reveal additional problems that were missed in initial medical evaluation. And, the counter-claims always give the attorney a focal point to reassert the claims of the client.
This is especially true if the conditioning is worsening or the doctor’s assessment is requested by the employee or the law firm. It is important to remember that the findings can have an impact for either side. Many workers comp injury cases are high-value claims that often deal with total disability for the injured worker, and it is imperative to have a trained professional negotiator representing your interests in the case.
Insurance providers will always have a team of legal professionals, and injured workers need a solid team as well. And, this is especially true when a personal injury case is available in addition to the comp claim. Employers who are not compliant with all OSHA rules and regulations for their industry could be held liable when they have any level of negligence, and especially when gross negligence can be proven.
The law firm that is chosen in personal injury cases can be the difference in whole damages for the injured claimant versus a seriously reduced claim settlement.