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Independent Medical Evaluations

  • Dave Brown, Esquire
  • 10/26/2020

If you have been collecting workers’ compensation benefits, or you have injured yourself at work and your claim has been denied, it’s very likely that you will be asked by the workers’ compensation insurance company for your employer to attend what is called an “independent medical examination,” or IME for short. The insurance company has the right under Pennsylvania workers’ comp. law to have you submit to an IME whenever there is a petition involving your right to benefits before a Workers’ Compensation Judge, or if there is not, once every six months.

It’s important that you understand the word “independent” in this context is misleading. Independent suggests neutral, which these evaluations most definitely are not. The doctor is picked by the insurance company, the evaluation is scheduled by the insurance company, and the doctor’s fee is paid by the insurance company. Some of these doctors perform as many as five or six IMEs a week, so they make significant income doing these exams.

After the doctor evaluates you, he or she will review medical records from doctors who have treated you for the injuries you sustained at work, and then write a report providing opinions on your diagnosis, ability to work, and whether you have fully recovered from your injury. If the doctor renders an opinion favorable to the insurance company, such as you have recovered completely from your injury and can return to the job that you were doing at the time of your injury, the insurance company will request that the doctor give a deposition in your case which will be submitted to the Workers’ Compensation Judge by the insurance company’s lawyer to try to cut off your benefits. While doctors are paid well for the IMEs they perform, it’s a drop in the bucket compared to what they get paid to do depositions. They are paid thousands of dollars to give a deposition, and therefore have a substantial incentive to provide an opinion which the insurance company can use to its advantage in your case.

So what should you do if you are asked at attend an IME? First off, if you don’t have a lawyer, you should call Pearson Koutcher Law so that one of our lawyers can represent you in your workers’ comp. claim. We will tell you initially that the insurance company is required to provide you with transportation to and from the IME at no cost to you. A driver will come to your home and pick you up, drive you to the exam, wait for you, and drive you home. You have the option of going to the exam yourself if you’re more comfortable doing that.

We will also stress to you that when you attend the IME, keep track of how long the doctor spends with you because these doctors often conduct very short evaluations, spending 10 minutes or less taking a history (asking questions about how the injury occurred and the treatment that has been received) and performing the exam. If the doctor does in fact conduct a short evaluation of you, and then writes in his report that you fully recovered, your lawyer can question the doctor on the length of the evaluation and make the argument to the Judge: How could the doctor conclude that you completely recovered from your injury based on such a short exam?

Make sure that you tell the doctor about any injuries you had before you suffered your work injury. Here is an example to show why this is important. Let’s say that a year before you injured yourself at work, you hurt your back when you were rear-ended in a car accident driving to the grocery store. After the accident, you went to the hospital, missed a few days of work, and underwent some physical therapy – and then your back was fine. And then, nine months later, you injured your back again while lifting a heavy box at work. If the IME doctor asks you about previous back injuries, you should tell him about the car accident – you injured your back, it wasn’t too serious, and within three months you had recovered. But if you don’t mention the accident because you’re afraid it might hurt your workers’ comp. case, the IME doctor will try to use that against you and write in his report that you were not completely candid when giving a past medical history. So our best advice is to answer all questions that you are asked by the doctor completely and forthrightly and you will help yourself.

Another thing to keep in mind is these doctors are known for writing in their reports that patients exaggerated their complaints based on the examination that they performed. There are maneuvers called “Waddell tests” in which the doctor will try to determine if you are exaggerating. For example, the doctor may tap lightly on your head and ask you if that hurts. Even if you have a significant back injury, a tap on the head should not provoke an increase in your pain. If you cry out in pain when your doctor does this test, he will write that this is an indication of exaggeration or malingering. Our advice is to tell it like it is – if the maneuver hurts, tell the doctor that it does; if it does not hurt, tell the doctor it does not hurt.

These IMEs are important tools for insurance companies. You need an experienced, knowledgeable workers’ comp. lawyer to guide you through the process and make sure your rights are fully protected. At Pearson Koutcher Law, workers’ comp. is all we do. So if you receive an IME letter – or just injure yourself and are worried the insurance company will try to take advantage of you — please call us for a free, comprehensive consultation.