Nervous about having an independent medical exam? you ought to be. find out how insurance firm doctors can make or break your workers’ compensation claim.
Navigating the workers’ compensation medical process can add even more discomfort to a painful work injury. Each state has its own rules and regulations regarding workers’ comp claims, but one rule is common to all: Injured workers seeking benefits must be evaluated and diagnosed by workers’ compensation doctors approved by the employer’s insurance firm .
For many injured workers, meaning facing an Independant checkup , or IME ordered by the workers’ compensation insurance firm .
Can You Be Forced to Have an Independent Medical Exam?
If you’re injured on the work and making a workers’ compensation claim, you want to be medically evaluated and treated by doctors who are approved by your employer’s insurance firm . Virtually all state regulations permit you to be treated by your own doctor, but your claim is very hooked in to the medical opinion of the doctor from the insurance company’s approved list. Several circumstances may cause the insurance firm to request that you simply undergo an Independent checkup (IME).
The insurance firm calls it an invitation , but the hard truth is that if you refuse to undergo the IME, your claim are going to be flatly denied. Game over. Remember that the workers’ comp insurance firm will do whatever it takes to save lots of money. That means limiting benefits and wage payouts to injured workers such as you . The fastest way for the insurance firm to justify limiting your workers’ comp is to possess medical “proof” that you’re able to return to figure .
IME Doctors Work for the Insurance Company
Doctors have various reasons for deciding to figure for an insurance firm , but like most of the people within the workforce, their goal may be a paycheck. Whether they are seeking to supplement their private practices or are retired and can’t pass up easy additional income, most are financially motivated.
IME Doctor Qualifications
You won’t often find doctors certified in surgery, orthopedics, or other specialties performing medical evaluations for workers’ comp insurance companies. Frequently, doctors primarily handling work accident claims are considered “fringe” doctors. Many don’t continue with the newest medical literature, pursue continuing medical education, or stay current within the latest medical technology. Some are general practitioners with limited or no previous experience in workplace injuries.
Workers’ Comp Doctors Protect Company Profits
Workers’ compensation doctors know insurance companies don’t like pocket money on expensive tests like MRIs and CT scans. These tests are expensive and complicate the whole claim. Even when doctors would normally recommend those diagnostic or therapeutic services, in workers’ comp cases, they won’t mention it to the injured worker. It’s easier for the IME doctor to only side-step having to affect your frustration or an issue with the insurance firm .
As a result, many insurance company-approved doctors are more likely to treat injuries with pain medication. Pills are much less expensive than an MRI. Workers’ comp IME doctors know that if they verify the severity of your injuries, the insurance firm will need to pay your benefits accordingly. They also know the insurance company won’t like it. To remain on the list for workers’ comp referrals, some doctors may classify patients as malingerers, instead of diagnosing real pain issues and injuries with implications for long-term disability.
Workers’ Comp Doctors Don’t Care About You
There is no such thing as a very independent checkup . Doctors hired to perform IMEs are paid by the workers’ comp insurance firm handling your claim. In most cases, the adjuster working your claim chooses the IME doctor you'll be required to ascertain . Remember, if you refuse to undergo an IME, the insurance firm can legally deny your workers’ compensation claim and stop your medical and wage replacement benefits.
The IME Won’t Take Long
The workers’ comp doctor isn’t there to treat you or assist you affect your work-related injuries. The doctor selected to perform your IME is meant to review all the medical notes and documents associated with your claim, discuss your injury, and examine you.
In reality, the examinations are usually very short, some lasting but ten minutes. Most doctors who perform Independent Medical Exams have little incentive to require the required time to review all the documentation associated with your claim.
Workers’ comp doctor fees are supported the amount of patients, not on the time spent on each case. The more patients pushed through during a day, the faster the fees rack up.
Double-Dipping IME Doctors
Another potential conflict of interest arises when doctors own or have financial connections within the healthcare facilities they're referring you to for diagnostic exams or treatment.
Because of their financial interests, some doctors may order unnecessary or questionable tests or treatments hoping the insurance company will pay for them. Like the doctor who orders custom braces or orthotic shoe inserts that can only be made by a company owned by the doctor.
Should the insurance firm consider those tests or devices medically unnecessary, you'll be personally liable for the prices of the tests or other extended treatment.
What To Do Before, During and After an IME
How to Get Ready for an Independent Medical Exam
You can’t refuse the insurance company’s request for an IME or you’ll risk losing all of your workers’ comp benefits. But, you'll ratchet back a number of the strain of facing an IME by brooding about what you’ll be asked by the doctor and being prepared to offer complete and honest answers.
If possible, have a lover or relative accompany you to the IME. It never hurts to possess your own witness to the exam. They won’t be allowed to speak but ask them to take notes.
What are the issues?
The insurance firm will send copies of your medical records to the IME doctor well before the scheduled exam date, usually along side a canopy letter telling the doctor what they want to know about your condition.
Try to get a copy of that letter. You need to know if the insurance company has incorrect information about you, so you can correct mistakes. Make the request in writing and send a copy of your request to your state’s workers’ comp board.
How did the accident happen?
Review exactly how the accident happened and be prepared to re-tell the small print to the IME doctor. Yes, the doctor should have that information from your medical records, but they’ll want to listen to it from you.
Take your time. The IME doctor are going to be trying to find inconsistencies in your story, so don’t let anyone rush you. Don’t volunteer your opinions, just relate the facts.
What to Expect During Your IME
You have no right to confidentiality with this checkup . Everything you say or do will be reported to the insurance company and can be used against you.
You’ll be observed from the time you reach the IME location. They’ll be looking to ascertain if you hop easily out of your car and walk briskly to the building, only to limp and groan as you struggle to ease into a chair in the waiting room.
What’s your medical history?
Don’t try to conceal pre-existing conditions. If you’ve got prior injuries or a pre-existing medical condition, be prepared to elucidate how this work injury and it’s affect on you is different and distinct from your condition before the work injury.
How are you today?
Tell the IME doctor every detail about your pain management, mobility struggles, and the way your work injury affects your activities of daily living. Don’t exaggerate, but don’t leave anything out.
There may be details that are embarrassing but are impacting the quality of your life. If you haven’t been ready to dress yourself since the accident, or sometimes have trouble making it to the toilet in time, you want to speak up.
Remember that insurance companies often have injured workers under surveillance. If you say you can’t drive, lift or bend, you'll forfeit your workers’ comp claim if the insurance firm has videos of you loading groceries into your car.
Be on time and be careful. Whether the IME doctor and staff are pleasant or rude, you ought to be polite and always think before you speak.
Do This After an IME
Even if you brought a witness to take notes during the IME, make your own notes about the exam while it’s all fresh in your mind. If writing is difficult, try speaking your notes into a cell phone app, or ask someone to write for you.
Request a copy of the IME doctor’s report. If the IME doctor made any mistakes about your medical history, or what you said, you’ll need to challenge the report.
Be Careful of the Nurse Case Manager
Nurse case managers are registered nurses whose job is to facilitate communication between the doctor and therefore the insurance firm . You may have a nurse case manager assigned to assist you together with your claim.
The nurse may present herself as your advocate who is acting in your best interests. Although most nurses are honest and hard-working, don’t forget that the nurse is used by the insurance firm .
You Have A Right to Medical Privacy
The insurance firm nurse may demand to be within the room when your doctor is examining or treating you and won’t hesitate to challenge your doctor’s opinion. In most states, you'll refuse to possess the nurse within the examination room with you while you're seeing the doctor. Also, you don’t have to speak with the nurse.
With the nurse case manager within the room, anything you say or do during the examination are often used against you. The nurse will report anything you say or do to the insurance firm with no regard for your personal privacy.
For example, she may afflict your doctor about your pain or mobility level and once you should be released to travel back to figure . In that case, she could recommend that you simply be sent for an independent checkup with a special workers’ comp insurance firm doctor. Remember, it’s you against the insurance firm , and therefore the nurse case manager is simply another of their employees.
How to Protect Your Workers’ Comp Claim
If you're completely satisfied with the extent of care and treatment from the workers’ compensation doctor, and therefore the amount and duration of your wage replacement benefits, there’s nothing more you need do. But if you're feeling you are being played by the workers’ comp insurance firm , otherwise you aren’t sure you’re getting the advantages you deserve, don’t wait to guard your claim.
You have the proper to hunt a second medical opinion if you are feeling the workers’ comp doctor isn’t addressing your medical issues.
Most insurance companies permit an injured worker to possess a second evaluation from another doctor on their approved list. While second opinions could seem helpful, the opposite doctors is getting paid by the insurance firm , a bit like the primary one.
Ask your attorney how to proceed.
After a specified time from your claim filing, you’ll be permitted to have an evaluation and treatment from a physician you choose, whether on the insurance company’s approved list or not. Getting a second (and sometimes third) medical opinion can help support your claim.
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