The independent medical examination (IME) is a process typically requested by your employer’s insurance company that involves a physician examining your work-related injuries and asking questions regarding the accident. An IME is a defense medical examination. Read on for the complete guide to IMEs and FAQs answered by expert Philadelphia workers’ compensation attorneys at Pearson Koutcher Law.
The workers’ compensation insurance company will ask that you be examined during an independent medical examination anytime you have a work injury. The doctor can ask you questions, have you complete an information sheet or questionnaire, and perform a physical exam. The exam is not intent upon treatment, and no establishment of a doctor-patient relationship is typical. If you have questions about what will happen during an IME, contact a workers’ compensation lawyer PA at Pearson Koutcher Law.
After the doctor evaluates you, they will review medical records from doctors who have treated you for the injuries you sustained at work. The doctor will 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, the insurance company may request the doctor to give a deposition in your case. The deposition will be submitted to the Workers’ Compensation Judge by the insurance company’s lawyer to try to cut off your benefits.
Complete recovery from your injury and return to the job you were doing at the time of your work accident is one scenario in which insurance companies may request deposition.
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 receive thousands of dollars to give a deposition. Therefore, physicians have a substantial incentive to provide an opinion. The insurance company can use it to its advantage in your case.
Yes, you will most likely have to attend an IME. If you refuse to appear for this examination, the employer may seek an order from the Workers’ Compensation Judge requiring your exam attendance. Continued refusal to attend may result in a suspension of your workplace compensation benefits.
Free transportation to and from the IME is a requirement for the insurance to provide, should you need it. A driver will come to your home and pick you up, drive you to the exam, wait for you, and drive you home. You can attend the exam alone if you prefer.
Attendance to your IME is integral to the insurance company’s gain. IMEs allow insurance companies to handpick the doctor to obtain a favorable opinion that benefits the insurance company. Then, the insurance company can begin trying to modify or even stop your benefits. Sure, some doctors evaluate an injured worker objectively and fairly during a defense medical examination. A large majority of doctors who perform medical exams, however, are not fair or objective. Typically, insurance companies select the same physicians to perform these exams. The exams are brief, can be adversarial, and may leave the injured worker in more pain or symptomatic than when they arrive.
IME doctors often conduct short evaluations, spending 10 minutes or less documenting a history (asking questions about how the injury occurred and the treatment plan) and performing the exam. If the doctor does conduct a short evaluation during your IME and then writes in his report that you fully recovered, your PA workers’ compensation 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?
Ensure you tell the doctor about any existing injuries before your work injury.
Here is an example to show why transparency in IMEs is essential:
A year before you injured yourself at work, you hurt your back when you were rear-ended in a car accident while 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 your recovery took three months. However, if you don’t mention the accident because you’re afraid it might hurt your workers’ comp. case, the IME doctor may try to use that against you and note that you were not candid when giving a past medical history in their report.
Workers’ compensation lawyer PA professionals advise you to always be honest with the doctor. These doctors are known for writing in their reports that patients exaggerate their complaints based on the examination that they performed. IMEs typically include Maneuver tests called “Waddell Signs.” Doctors use Waddell Signs to determine if you are exaggerating your injuries.
For example, the doctor may lightly tap on your head and ask you if that hurts. Even if you have a significant back injury, a tap on the head should not spike a pain increase. If you cry out in pain when your doctor does this test, he will write that this response indicates exaggeration or malingering. Our advice is to tell it like it is – if the maneuver hurts, inform the doctor it does; if you don’t experience pain, share with the doctor it does not hurt.
The Pennsylvania Workers’ Compensation Act allows the employer to request that an injured worker submit to an examination by a physician as selected and paid by the employer. Procedures recommended by a physician during an IME must meet the standard of reasonable and necessary, relevant to the risk, intrusiveness, and scope of the examination. From the injured worker’s perspective, since there is no physician-patient relationship created during an IME, a physician during an IME should not be permitted to perform or request any procedure that involves any risk as there would be no legal recourse against the provider should something go wrong.
IME doctors can request diagnostic imaging during an exam. Diagnostic studies, such as MRI or X-rays, are therefore most likely to fall within the definition of physical examination, as would a request that an injured worker attend a Functional Capacity Evaluation (FCE). As long as the employer can show these studies and tests are necessary, involve no more than minimal risk, and are not unreasonably intrusive, the injured worker will most likely need to follow through with the suggestions of the IME physician.
If you have been sent to a defense medical examination by your employer or its workers’ compensation insurance company, contact Pearson Koutcher Law for legal counsel. Through aggressive and skilled cross-examination of doctors who perform defense medical examinations, our Philadelphia workers’ compensation attorneys bring physician bias and financial incentives to light, casting doubt on the credibility of their opinions.
Below are a handful of settlements our PA workers’ compensation lawyers have obtained for injured workers who attended IMEs.
A Texas resident working in Pennsylvania in a gas well suffered severe and debilitating burns on a significant part of his body, resulting in severe, permanent, and unsightly scarring on his head, face, and neck. This client’s injuries were also limiting the use of his upper extremities. The injured worker was paid workers’ compensation wage-loss benefits under the laws of the state of Texas. When benefits in Texas stopped, Jonathan Koutcher of Pearson Koutcher Law filed a claim petition in Pennsylvania.
Mr. Koutcher litigated the case, arguing the injured worker was disabled and, in addition, required ongoing medical care. Mr. Koutcher also pursued a claim for disfigurement benefits for the injured worker. Despite the insurance company alleging the injured worker could return to work based on the opinions of two physicians who performed independent medical evaluations, Mr. Koutcher secured a significant settlement of $375,000. Part of the settlement to the injured worker was in the form of a structured annuity, and as a result, the total settlement value exceeded $375,000.
Jonathan B. Koutcher of Pearson Koutcher Law settled the case of a Philadelphia Union electrician with a shoulder injury. The injured worker’s job was physically demanding, requiring repetitive use of the arms and working at heights.
After the Workers’ Compensation insurance company had the worker examined during an IME, the injured worker needed representation and retained Mr. Koutcher. With his strategies for the next steps in the case and coordination for medical treatment, he ensured the case remained strong. The injured worker was nearing retirement age and decided a settlement was in the injured worker’s best interest. Mr. Koutcher negotiated a lump sum settlement for the injured worker for $180,000.
Jonathan B. Koutcher of Pearson Koutcher Law settled the claim of a salesperson with a lower back and knee injury for the lump sum of $160,000. The injured worker was in a sales position at a nutritional blender company. The job was physically demanding, requiring long hours of work.
The Workers’ Compensation insurance company initially agreed to begin payment of Workers’ Compensation wage loss benefits. After an IME of the employee under the insurance company’s chosen physician, The Workers’ Compensation insurance company instituted litigation against the interest of the injured worker. Not only did Mr. Koutcher defend the injured worker against benefit termination, but he also filed a petition to include injuries not initially accepted as work-related.
A firefighter injured his lower back and was receiving treatment from an orthopedist. He did not feel he could return to his job as a firefighter. The workers’ compensation insurance carrier filed a Petition to Terminate Compensation Benefits based upon the examination of the physician it chose to perform an IME. Litigation ensued, and the injured worker’s benefits were in jeopardy. The injured worker was under the representation of Philadelphia workers’ compensation attorney Jonathan Koutcher of Pearson Koutcher Law.
Mr. Koutcher devotes his practice to representing injured workers and is certified as a specialist in workers’ compensation. The employer, a city municipality in Delaware County, rarely settled Workers’ Compensation cases; however, a settlement agreement was made after the parties attended a Mediation and some additional negotiating. Most significantly, the injured worker was in a Union and had certain benefits that were preserved, as the injured worker was not required to resign/retire as a condition of the settlement.
At Pearson Koutcher Law, PA workers’ compensation is all we do. We have a team of lawyers with extensive experience representing injured workers. If you injure yourself at work, are getting the run-around from your employer and insurance company, and are looking for a workers’ compensation attorney near me, contact Pearson Koutcher Law. We put our decades of experience to work for you to help you navigate the complexities of the Workers’ Compensation laws.