The independent medical examination (IME) is really a defense medical examination. The workers’ compensation insurance company will ask that you be examined during an independent medical examination any time you have a work injury. The doctor can ask you questions, have you complete an information sheet or questionnaire, and of course perform a physical examination. The exam is not for treatment purposes and no doctor-patient relationship is established.
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.
Yes, you will most likely have to attend an IME.
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.
Because the insurance company handpicks the doctor to try to obtain a favorable opinion that benefits the insurance company. Then, the insurance company can begin the process of trying to modify or even stop your benefits. Sure, there are some doctors who evaluate an injured worker objectively and fairly during a defense medical examination. A large majority of doctors, who perform medical examinations, however, are not fair or objective. Typically, the same physicians are chosen by the insurance company to perform these exams. The exams are brief, can be adversarial and may leave the injured worker in greater pain or more symptomatic than when they arrive.
IME 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.
Also, always be honest with the doctor. 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.
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, which is linked 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.
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 are being sent to a defense medical examination by your employer or its workers’ compensation insurance company, contact the aggressive workers’ comp lawyers at Pearson Koutcher Law. Through aggressive and skilled cross-examination of doctors who perform defense medical examinations, we bring to light the bias and financial incentive of those physicians, casting doubt on the credibility of their opinions. Here are some settlements our workers’ comp lawyers have obtained for injured workers who attended IMEs.
$375,000 Workmens’ Comp Settlement for Texas Resident Injured Working in PA
A Texas resident working in Pennsylvania in a gas well suffered severe and debilitating burns on a significant part of his body resulting in serious, permanent and unsightly scarring on his head, face and neck and also limiting the use of his upper extremities. The injured worker was paid workers’ compensation wage-loss benefits pursuant to the laws of the state of Texas. When benefits in Texas stopped, Philadelphia workers’ compensation attorney 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 upon opinions of two physicians who performed independent medical evaluations, Mr. Koutcher was able to secure a significant settlement in the amount 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.
$180,000 Lump Sum Settlement for Union Electrician
Pearson Koutcher Law partner, Jonathan B. Koutcher, 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 injured worker examined during an Independent Medical Examination (IME), the injured worker needed representation and retained Mr. Koutcher, who strategized the next steps in the case, coordinated medical treatment and 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 in the amount of $180,000.
$160,000 Lump Sum Work Injury Settlement for Delaware County Salesperson
Philadelphia Workers’ Compensation attorney 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 had been employed by a nutritional blender company in a sales position. The job was physically demanding requiring long hours of work. The Workers’ Compensation insurance company had initially agreed to begin payment of Workers’ Compensation wage loss benefits. The Workers’ Compensation insurance company then had the injured worker examined by its own physician during an independent medical examination and instituted litigation against the interest of the injured worker. Mr. Koutcher not only defended the injured worker against the termination of his benefits but also filed a petition to include injuries not initially accepted as work related.
Delaware County Union Fire Fighter obtains $105,00 Lump Sum Settlement
A firefighter injured his lower back, was receiving treatment from an orthopedist and did not feel he could return to his job as a fire fighter. The workers’ compensation insurance carrier filed a Petition to Terminate Compensation Benefits based upon the examination of the physician it chose to perform an independent medical examination. Litigation ensued and the injured worker’s benefits were placed in jeopardy. The injured worker was represented by 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, after the parties attended a Mediation, with some additional negotiating thereafter, a settlement was reached. Importantly, 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.
Let us put our decades of experience to work for you, helping you navigate the complexities of the Workers’ Compensation laws.