Workplace accidents happen every day in California. Despite the state’s employee-friendly laws, many workplaces can contain hazards that put workers at undue risk of accidents and injuries. Employers may ignore injury risks to save time or cut costs. When an accident happens, injured employees have the right to file workers’ compensation claims for monetary damages. Part of the claims process may be a mandatory IME, or independent medical examination.
An independent medical examination is a checkup from a third-party physician, usually of the insurance company’s choosing. Rather than using the results of an initial medical exam by the employee’s regular doctor, an insurance company in California may require an IME for a second opinion. An IME can answer questions about the employee’s medical condition, such as its cause and severity. The goal of an IME is to yield an objective assessment of a worker’s injury, illness or other medical conditions.
If a workers’ compensation insurance company requires an IME, it will typically select the doctor the worker must see. In these cases, the worker or his/her attorney will have the right to question the validity of the physician’s assessment. A doctor the insurance company chooses may be impartial to the insurer, or even working for kickbacks in an insurance fraud scheme. This could result in biased IME results that could hurt the employee’s claim. If an injured worker questions the impartiality of an IME doctor, he or she may be able to ask for another independent examination.
Many states have passed laws to help ensure the impartiality of IMEs. For example, an insurance company may have to choose a doctor from a preapproved list of physicians and specialists in the area. In other cases, a court judge may choose the doctor for an IME rather than the insurance company. A workers’ compensation attorney can safeguard a worker’s rights by ensuring the qualifications of the physician chosen to conduct an independent medical exam.
What To Expect During an IME
If an insurance company or employer requires an IME during a workers’ compensation claim in California, the injured worker will need to send his or her preexisting medical records to the new doctor. A phone call to the doctor or hospital can arrange the transference of medical records, including injury reports and statements related to the case. The physician for the IME can review these records before or after the new examination. In some scenarios, the insurer may write the new doctor a letter posing specific questions for the doctor to answer during the IME.
- Has the first doctor correctly diagnosed the condition?
- Could a work-related accident have caused the condition?
- Should the patient receive other types of treatments?
- When may the patient return to work, if at all?
- Does the patient have a permanent disability?
An insurance company’s goal with an IME is typically to answer questions about the worker’s condition, especially if the insurer does not trust information from an initial examination. The employee will have the right to review any letters the insurance company sends the new doctor for irregularities, inappropriateness and misinformation. Keeping copies of all communications between the insurance company and the IME doctor is important for the future of the claim.
Could an IME Hurt a Workers’ Compensation Claim?
An employee should be careful of what he or she says to an IME doctor. In most cases, a normal doctor-patient relationship does not exist during an IME. Instead, the doctor may tell anything the employee says to the insurance company. A doctor can also give his or her personal observations to the insurance company, such as if the doctor thinks the worker is faking or exaggerating an injury. The insurance company and a judge could take anything the IME doctor says into consideration during a workers’ compensation case or hearing. Hiring a lawyer can help an injured worker protect him or herself if an insurer requests an IME.