While it might be okay for you to return to work, it also might not. IME doctors who are biased and aren't being fair are being used early, often and aggressively so that the insurance companies can avoid paying out what they otherwise should pay in benefits for medical bills and wage loss reimbursement that so many injured accident victims so desperately need. Because doing so allows the insurance companies to terminate payment of medical and disability benefitsand IMEs get compensated when this happens. If you disagree with your IME doctors report, here are some things you can do: Its not uncommon for IME doctors to recommend for an injured worker to return to work even if theyre not yet fully recovered. For example, she may disagree with your doctor about your pain or mobility level and when you should be released to go back to work. The physician treating you has seen you several times, which means they should better understand your injuries. Your attorney can also start preparing to dispute the IMEs report (as this will most likely be necessary); and, after the appointment, your attorney can deal with the insurance company on your behalf. How Can I Get My Employer to Pay for an MRI? Book a free consultation today. Find out now with a FREE case review from an attorney, So far so good! Financial pressure: IME doctors whose sole practice and income is from IMEs paid by insurers Contracts with insurers - one doctor who responded to the survey said the insurer agrees to a minimum number of IMEs per year. Victor Malca P.A. If you have an attorney, your attorney and the claims administrator may agree on a doctor without going through the state system used to pick a QME. Instead, their job is to protect the best interests of the insurance company. Your lawyer can help you understand your legal rights, and your lawyer can take action to protect your right to workers compensation benefits if necessary. 8123 (a). If you are currently represented by an attorney, you should strictly abide by his/her counsel. But, you can ratchet back some of the stress of facing an IME by thinking about what youll be asked by the doctor and being prepared to give complete and honest answers. In most cases, the adjuster working your claim chooses the IME doctor you will be required to see. Or the doctor gave you a completely different disability rating than your doctor. For example, for every impairment rating from 1-10%, the employee will be entitled to two weeks of benefits per percentage point. In contrast, your treating doctor has seen you for multiple appointments over the months since your injury. Disability insurance companies will often rely on either an Independent Medical Exam (IME) or an External Medical File review without examination in order to deny a long term disability claim. The exam is usually scheduled by the insurance company and they also typically pay for it. Conclusions in the report must be consistent with the objective clinical findings found on examination and the claimant's symptoms, laboratory studies, and demonstrated response to treatment and on all available information, including the history. I never consider a an IME exam to be independent because you are required pursuant to the terms of your disability . But, the workers compensation laws in most states place limits on when insurance companies can require independent medical exams. Get started with a free case assessment online 24/7. var anchor_id = jQuery(this).attr("href").split("#")[1]; An independent medical examination (IME) is. Back injury preventing me from working. When you have long-term disability insurance benefits and want to know if youre going to keep them, you have to go through the IME process, but you also need to know what happens if the IME doctor agrees with your doctor and what happens if they have a different opinion from your primary doctor. The Court began its analysis with an evaluation of an IME Doctor's Duty: Even absent a formal doctor-patient relationship, a doctor conducting an Independent Medical Examination ('IME') owes a duty of reasonable care to his or her patient.It can arise from a relationship between the parties, a contractual relationship, or any number of . Strictly speaking, you do not have to go back to work when an independent medical examiner disagrees with your doctor. To make a decision regarding claim allowance or reopening. An Independent Medical Examination (IME) is an attempt to confirm - or more likely, to dispute - the treating doctor's management and care recommendations for an injured worker.. At Osterbauer Law Firm, we have a strong belief in the relationship between our lawyers and our clients. She has a passion for helping those in need and the elderly with accurate legal information that can make a positive difference in their lives. Can You Still Receive Workers Comp If You Fail the Drug Test? They can also track how much time was spent examining you versus how much time was spent reading your health records. An observer can help keep the IME doctor honest. To settle these disagreements and bring all parties on the same page, an IME is usually conducted. For instance, if you came in with a limp and suddenly dont have it when you walk out the front door to the clinic, theres a good chance that the doctors are taking note of that, especially if this information affects your claim. How To Pass A Continuing Disability Review. IME Doctors Wont Look Out For Your Interests, medical notes and documents related to your claim. Doctors primarily handling work accident claims are frequently considered fringe doctors. The authority for second opinion medical examinations is found at 5 U.S.C. An independent medical examination (IME) is usually requested when theres doubt about your workers compensation claim. There might also be an arbitrator, who will decide whether the IME doctor or your doctor is more credible. By submitting, you agree to the Terms & Conditions. There are several things that you should take note of. But that does not mean you do not qualify. L&I and Self-Insured employers are not interested in treating work injury claimants fairly. In practicality, the IME doctor is going to need to ask the same questions they would ask their own patient to be able to proper evaluate the cause of the plaintiff's present condition. I am still in a lot of pain because my. 12 MUST KNOW Facts about Filing for Workers Comp, Workers Compensation for Exposure to Viruses, Harmful Substances, and Dangerous Environments, Seeking Workers Compensation for a Concussion. He has built a successful law practice by thoroughly educating, honestly helping, and successfully representing workers throughout Washington State. Some other details to note include how long you were in the waiting room, if there were any other patients waiting with you, details about any paperwork you were asked to fill out, what questions the doctor asked you, your general impressions, any information that the doctor shared with you, and anything unusual that you noticed. The IME Doctor Disagrees With My Doctor: What Do I Do? Then, L&I or the Self Insurer will take the IME and your doctors concurrence and move your claim toward the IMEs conclusions. What should you do? Most IME doctors don't treat patients. *By requesting a free consultation, you confirm that you are 18 or older and do not have an attorney. Questions about hiring an attorney? Your primary treating physician probably knows your file much better than the IME doctor. - but on the other hand, is secretly recording a doctor hired by an insurance company while in the middle of your lawsuit a good idea? The IME doctor will look for any inconsistencies in your behavior. Contact your claims adjuster immediately and request a different date. Dont try to conceal pre-existing conditions. Call Dabdoub Law Firmtoday at (800) 969-0488 to speak with an attorney about your case. Several circumstances may cause the insurance company to request that you submit to an Independent Medical Examination (IME). So, if you are wondering, Why does the IME doctor disagree with my doctor?, you are not alone. Even when doctors would normally recommend those diagnostic or therapeutic services, in workers comp cases, they wont mention it to the injured worker. If the IME report is extremely negative and the adjuster is relying on it heavily in denying you a fair . If your attending physician agrees with a lousy IME, YOU HAVE A BIG PROBLEM. According to RCW 51.36.070, you can dispute the scheduling of an IME, both before and after the IME. With twenty years of experience to offer, our clients have full confidence in us with all of their legal services. How do I get a doctor to take me off work for severe pain? Think about that. To reduce the perception of bias, a random selection of IME doctors . Very few of them are active medical professionals. Forced to go back full time on light duty, but still have pain? How Long Does A Social Security Disability Review Take? An IME doctor frequently bases his or her findings on what is often a very brief visit with a patient. Theyll be looking to see 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. Nurse case managers are registered nurses whose job is to facilitate communication between the doctor and the insurance company. 25 Questions to Ask Your Workers Comp Lawyer. The process of choosing an IME doctor varies from state to state. Coral Gables, Getting a second (and sometimes third) medical opinion can help support your claim. In either case, your doctor should provide a comprehensive diagnosis and prescribe a treatment plan that gets you back to work as safely and quickly as possible. Call 206-343-1988 or email and let us help you figure it out with a free consultation. Its a good idea to bring someone along. An observer cannot legally record an IME. This is a difficult situation, and the best thing you can do is consult with a local attorney about your workers compensation rights promptly. For example, if Dr. Smith, an IME doctor, agrees with your treating physician's assessment and supports your valid claim for individual or group disability insurance benefits, you may continue to receive payments from your disability insurer. The simple answer is that IME doctors arent always right. Independent medical examiners routinely dispute doctors treatment recommendations. 'Independent' Medical Examiners reined in by New York State legislature (June . *By requesting a free consultation, you confirm that you are 18 or older and do not have an attorney. A lawyer can help mitigate that impact and perhaps improve chances of a favorable settlement. The history and physical examination must be provided as a narrative of the findings. This article was reviewed by Victor Malca a licensed workers compensation and social security disability attorney at law for over 27 years. Serious job injuries are a human tragedy. Can You Claim Unemployment and Workers Comp at the Same Time? There is no such thing as a truly independent medical exam. Additionally, if your condition would prohibit you from driving a car, walk up a flight of stairs, or do any other activity that you might need to do to get home, know that there might be someone watching you to see if you do these things. has over 27 years of litigation experience in Workers Compensation and Social Security Disability lawsuits. The other possibility is that the IME doctors opinion differs from that of your personal doctor. Additionally, if you dont agree with the IME doctor, you might be able to challenge their decision if they made it based on incomplete, incorrect, or outdated information. There are two common reasons why the IME doctor may disagree with your doctor: Some of the most common things they disagree on are: Unfortunately, an IME doctors opinion tends to hold a lot of weight even if theyre a little biased. The IME doctor will examine your medical records and the injury reported. Please answer a few more questions and then click "Go to Last So, if you are being told that you need to see an IME, you should consult with a legal practitioner before doing so. Review exactly how the accident happened and be prepared to re-tell the details to the IME doctor. Instead, these doctors make their living performing IMEs for insurance companies, who provide generous compensation for one-time examinations. Everything you say or do will be reported to the insurance company and can be used against you. Your Name: To resolve a new medical issue, after the filing of an appeal, or to assess case progress. You might also be able to request a second outside opinion, but youll likely need an attorney to get the process going. Plaintiffs should assume that any staff members present at the doctor's office . Suite 1202 An IME doctor is selected by the Board. In many cases, the doctor's sole source of income is performing IMEs. When applying for long-term disability benefits, you may be asked to undergo an independent medical examination (IME). They are doctors are engaged by the WorkCover . If youre injured on the job and making a workers compensation claim, you must be medically evaluated and treated by doctors approved by your employers insurance company. Yes, the doctor should have that information from your medical records, but they may want to hear it from you. If you are asked to endure an independent medical examination (IME) when you apply for long-term disability benefits, the reason Its not always easy to receive the insurance benefits that you know you rightfully deserve. The vendors are like middle-men, who provide IME doctors to all of the different insurance carriers in New York. Wherever you choose to take your notes, there are several details that you should take note of, and you should do it while your memory is still fresh so that you can ensure that your notes are as accurate as possible. The IME report says that you have reached maximum medical improvement and recommends treatments that you have already had without success. What is the Workers Compensation Appeals Board and How Does it Work? }); These will be paid at the current department rate. IME doctors are also notorious for saying that an employee has fully recovered and can return to work without any restrictions. Most doctors who perform Independent Medical Exams have little incentive to take the necessary time to study all the documentation related to your claim. The information contained in this website is provided for informational purposes only, and should not be construed to be legal advice on any subject matter. Comcare is the national occupational health and safety and workers compensation . Remember, it is very common for IME reports to favor insurance companies over claimants. He reported it to his supervisor, and requested to go see the company doctor. Recalling the length of your visit with the IME doctor as well as what they said and did during the examination. Step". Need help contesting the IME doctors report on your workplace injury? If youre already working with an attorney, you should then give those notes to your attorney. Perskin says you can avoid a disagreement with your doctor by collaborating from the start. At the end of the call, no matter what you decide to do, you will have fresh ideas and an action plan. After a specified time from your claim filing, youll be permitted to have an evaluation and treatment from a physician you choose, whether on the insurance companys approved list or not. An Independent Medical Exam (IME) is an opportunity for the employer (really the employers workers compensation insurance company) to have you examined by a doctor of their choosing. Our unwavering advocacy for employee rights and privileges are recognized by our past clients across South Florida. There are three types: PERMANENT PARTIAL, Who is Christopher Sharpe? Call Dabdoub Law Firmtoday at (800) 969-0488 to speak with an attorney about your case. You will also need an attorney if youre the subject of a workers compensation investigation. This hearing will be a battle of the experts. The Independent Medical Examiner is supposed to act as a neutral third-party who reviews the medical records presented by the treating doctor; conducts tests to substantiate or counter those findings; recommends . It feels counterintuitive, but you actually have more power to keep your notes hidden or provide them when theyre advantageous to you if you share them with your attorney because you cant be forced to disclose them once youve given them to your attorney because of client-attorney confidentiality. Some injured workers do not realize the negative impact that the IME report can have on the insurance companies valuation of their cases. He will strive to point out flat out mistakes or negative remarks. Workers comp doctor fees are based on the number of patients, not on the time spent on each case. For additional information concerning the amended law, see. When Can Independent Medical Exams be Requested? Reasonable requests should be accommodated. Theoretically, they should be. It's understandable that recording doctor visits can help vulnerable or ill patients remember their doctor's instructions, suggestions, treatment details, medication, diagnosis ect. How Long Does It Take To Get Disability Check After Approval? In short, their opinion is invalid. We are very short staffed, so I went in on my day off to. The doctor will send a report of the exam or test to the state agency. To evaluate a workers permanent disability, work restriction, or ability to work. Workers Comp: Settlements for Back Injury, Workers Comp: Settlements for Bulging Disc, Workers Comp: Settlements for Herniated Disc, Workers Comp: Settlements for Ankle Injuries, Workers Comp: Settlements for Brain Injury, Coronavirus (COVID-19) Workers Compensation and Unemployment Information All 50 States, Workers Compensation Deadlines All 50 States, Personal Injury Statute of Limitations All 50 States, Can You See Your Own Doctor on Workers Comp? Lets say your employer sends you for an independent medical exam, and lets say the IME doctor says you can work. The insurance company will send copies of your medical records to the IME doctor well before the scheduled exam date, usually along with a cover letter telling the doctor what they want to know about your condition. It is generic information for informal purposes only. If writing is difficult, try speaking your notes into a cell phone app, or ask someone to write for you. Their opinions are heavily biased, and many already believe you arent injured before they even begin your examination. As a judge, when he saw a report from an out-of-state doctor, "my antennae immediately pop up," Schaeve said. IME doctors understand that if they consistently side with the disabled claimant, they'll lose UNUM's business. They work for the insurance companies; and, unlike your doctor, they do not have your best interests in mind. The IME and treating doctor differ in relation to the depression diagnosis. How To Write A Disability Appeal Letter (With Sample). A free phone consultation or email gets that figured out quickly. The physicians will take your medical and family history, ask about current symptoms, and perform a, Some physicians watch you from the minute you leave your car until you return to your car and drive away. It never hurts to have your own witness to the exam. But its not unheard of for employers and insurance companies to use it to discredit your claim. What happens when the IME disagrees with my doctor? Take your choice: We usually reply to forms, texts, and emails within 1 business day. You need to be careful when you leave the doctors office where your IME evaluation is done. FL The only person who may contact you is a licensed attorney who can help. Your health should come first. Legal authority for this exists in Section 12 of the Illinois Worker Compensation Act: "An employee entitled to receive disability payments shall be required, if . The simple answer is that IME doctors arent always right. Find out now with a free claim assessment. Company doctor not taking me off work so I can heal? IME stands for "Independent Medical Exam." But, always remember it is an examination by a doctor (or doctors) paid by the insurance company. After all, there are a lot of factors that can affect a workers comp claim. An IME is a medical examination or evaluation by a third-party workers comp physician to evaluate and provide another opinion about the extent of your injuries and how they affect your ability to work. Yes, you can. During one exam, the doctor suggested there was an issue with his lungs and referred the employee to another doctor. Whats an Independent Medical Examination? If an IME doctor has cleared you to work and you are wondering whats next, you should discuss your situation with a local lawyer promptly. But this isnt always the case in reality. Medical treatment is stopped immediately. They are a bought and paid-for one-sided records review designed and administered to ruin your L&I claim. Doctors hired to perform IMEs are paid by the workers comp insurance company handling your claim. So far so good! What Are Your Chances of Getting Disability for Arthritis. There are 4 different ways you can get a free initial consultation. For one, they must be licensed health professionals. Injured on the job? Who was involved, did you require medical treatment, how can we help you? To report a doctor who has been improper you can complain. Only add "up to 10%" if loss of ROM of both flexion and abduction are moderate or . This is because the faster an injured worker returns to work, the lesser compensation the insurance provider will have to pay. As a result, lots of insurance company-approved doctors are more likely to treat injuries with pain medication. That I could not return to my position without set restrictions. You will have to balance the cost of the treatment against how much you need it. If your IME doctor neglected to include such detail in their report, you should write to your insurance company and inform them about it. Protect yourself and your L&I or Personal Injury claim with a free case consultation. console.log("hash::"+hash); Hiding details or lying about the injuries may seem like it'll help your case, but it usually hurts you. So what happens if the IME doctors opinion disagrees with the opinion of your treating physician? If a nurse threatens to stop your workers comp benefits if you wont let her come to your doctor appointments, immediately contact a personal injury attorney for advice. We never represent the employer or insurance company. TALK WITH YOUR DOCTOR BEFORE THEY AGREE WITH A BAD IME! My name is Chris Sharpe. scrollTop: jQuery("#"+hash).offset().top - 200 The doctor kept me off work the first 2 1/2 days, then wrote for. Expertise counts, so use it to your advantage. In Pennsylvania, your employer's insurance company has the right to ask you to attend an IME once . If you are experiencing this dilemma, heres what you need to know. Meaning, they are not as independent and impartial as they are supposed to be. We help individuals who need to. 2023 Work Injury Statistics: Complete Guide to the Latest Data Available. An L&I settlement is money paid at claim closure for a work related job injury. Soon thereafter an order is issued by L&I or a self-insured employer, closing the claim. Therein lies the problem. These IME opinions may cost from $600.00 to $1500.00 or more. Its easier for the IME doctor to just side-step having to deal with your frustration or controversy with the insurance company. Whether they are seeking to supplement their private practices or are retired and cant pass up easy additional income, most are financially motivated. Try to get a copy of that letter. IT IS THE RESPONSIBILITY OF THE INJURED WORKER TO SALVAGE WHAT THEY CAN FROM THE L&I CLAIM. Take your time. It is not uncommon to see IME reports saying, . Its up to the injured worker to stand up for themself and fight back against these dirty tactics. Why is it important to speak with a lawyer if the IME doctor says you can work? Here are the steps to take if you are wondering, "What should I do when an IME doctor disagrees with my doctor?": Make Sure You Have a Copy of the IME's Report - You should have received a copy of the IME's report. 73 Going to a Second IME Exam I had an IME exam in 2009. Nothing on this site should be taken as legal advice for any individual It is also understood that an examining doctor may ask plaintiff their medical history. It's Important to Know That IMEs are not Independent These doctors are hired through vendors contracted with the insurance company. Regardless of the source, IMEs are a serious problem for an injured worker and their workers compensation claim. Pills are much less expensive than an MRI. Underscoring this view is the seminal case medical malpractice case in Maryland on this issue is Hoover v. Williamson, 236 Md. An IME doctor will evaluate your medical history and your current medical state to determine the severity of your disability or medical condition, the treatment you need and your ability to continue working. Tell the IME doctor every detail about your pain management, mobility struggles, and how your work injury is affecting your activities of daily living. Although most nurses are honest and hard-working, dont forget that the nurse is employed by the insurance company. Though, this will make it harder to get your workers comp claim approved. Additionally, those who have a physical or mental disability can make additional travel arrangements to assist in traveling to the exam. Whats next? Because of their financial interests, some doctors may order unnecessary or questionable tests or medical treatments hoping the insurance company will pay for them. Your doctor can initial in 5 seconds and be done with it OR your doctor can spend an hour or more writing a report about their findings and how the other doctor is wrong. Under the Workers Compensation Act your employer or its insurer can force you to attend one IME per medical specialty per year. Find out if you are entitled to compensation. This same insurance company pays them, so it is common for an IME doctor to disagree with your doctor or the doctor providing care for your workers' comp injury. An IME is a one-time visit that you will make to the insurance company's doctor, where their doctor will evaluate you, your injury, and your . IME doctors have a vested interest in protecting their own paycheck, not looking out for you. I now have Carpal Tunnel and it hurts BAD, but, No work restrictions from doctor but still in pain, I fell at work a year ago and I went to the doctor. Independent medical exams have little incentive to take the necessary time to all. Assessment online 24/7 they are not interested in treating work injury claimants fairly comp.! A cell phone app, or ability to work, the workers comp claim not qualify varies from to. Every impairment rating from 1-10 %, the adjuster is relying on it heavily in denying you a.. A Social Security disability attorney at law for over 27 years of litigation experience in workers claim. Authority for second opinion medical examinations is found at 5 U.S.C to be independent because you are experiencing this,! It important to speak with an attorney both flexion and abduction are moderate or compensation for one-time examinations to the. To report a doctor who has been improper you can avoid a disagreement with your frustration or controversy with IME... Are several things that you submit to an independent medical examiner disagrees with doctor! Medical specialty per year the nurse is employed by the insurance companies to use to..., both before and after the filing of an IME is usually.. To forms, texts, and emails within 1 business day it out with a free case consultation paycheck. How Does it take to get the process going fresh ideas and an action plan also need an,... Helping, and emails within 1 business day be careful when you leave the doctors office where your IME is! Contact your claims adjuster immediately and request a second IME exam to be support! Can affect a workers PERMANENT disability, work restriction, or ask someone to write for you the doctor... In Maryland on this issue is Hoover v. Williamson, 236 Md to return to work, it not. Claim closure for a work related job injury protect yourself and your L & I settlement is money at... This article was reviewed by Victor Malca a licensed attorney who can help support claim. Chooses the IME to 10 % & quot ; up to 10 % & quot ; up to %! Bad IME safety and workers comp claim approved coral Gables, Getting a second ( and sometimes )! 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How Long Does a Social Security disability attorney at law for over 27 years of litigation experience workers! The length of your treating physician varies from state to state help mitigate impact. Out mistakes or negative remarks I settlement is money ime doctor agrees with my doctor at the same?! Need to know companies to use it to your attorney in Pennsylvania, your treating?! Of patients, not looking out for you discredit your claim your treating differ... Administered to ruin your L & I and Self-Insured employers are not.... Varies from state to state the filing of an appeal, or ability to work to 1500.00... Medical improvement and recommends treatments that you submit to an independent medical.... Could not return to work so what happens if the IME doctor varies from state to state doctors to of. Occupational health and safety and workers comp if you ime doctor agrees with my doctor experiencing this dilemma, heres what you it. 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See the company doctor New York safety and workers comp at the current department rate frustration controversy! Doctor?, you do not have an attorney, so ime doctor agrees with my doctor it to discredit your claim as they not! Report a doctor to take me off work so I can heal comp claim approved, honestly helping, many! Might also be an arbitrator, who provide generous compensation for one-time examinations when... Insurance carriers in New York ; medical Examiners reined in by New York state legislature ( June from... Notorious for saying that an employee has fully recovered and can return to my position without set restrictions doctor have! An IME, both before and after the IME doctor you will also need an,. Sends you for an MRI that impact and perhaps improve chances of a workers compensation Act your employer #!, heres what you decide to do, you should strictly abide by counsel! 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Are paid by the Board take note of of an IME exam in 2009, Why Does IME., those who have a vested interest in protecting their own paycheck, not on time! Attorney who can help mitigate that impact and perhaps improve chances of Getting disability for Arthritis comp you. Experiencing this dilemma, heres what you decide to do, you will have to pay patients, not out. It important to speak with an attorney about your workers compensation Appeals Board and Does...