When you file for workers' compensation, you may be asked to submit to an independent medical exam, or IME. This is basically a second medical opinion, which might contradict your doctor's assessment of your injury. If you need surgery, or long-term disability, an IME is more likely.
The bad news is that you must submit to an IME if the insurance company requests it. The good news is that IME physicians are appointed by the state, not the employer. The independent review may actually support your worker's comp claim and medical treatment plan. But they can also seriously undermine your claim. It must be taken seriously, and you need to be careful in your words and actions.
What is an independent medical exam (IME)?
Under Louisiana law, you can choose your own doctors for a work injury. (In many states, employers require you to see their “preferred” doctors.) Your physician will assess the extent of injuries and recommend a course of treatment. The doctor will also assess your capacity to return to work, including any permanent or partial disability.
The employer or its worker's compensation insurer may contest your injury claim, disputing specific treatment such as surgery or denying your claim entirely. Either party – you or the employer – may request an independent medical exam (IME).
- The Office of Workers' Compensation (OWC) will choose an independent doctor from a list.
- The IME is paid for by the employer, even if you request it.
- That physician will review your medical records in advance of the exam.
- The physician may conduct a brief medical exam and will ask a number of questions: what happened, what treatment have you received, how you are feeling, etc.
- The physician submits his or her report to the OWC within 30 days.
Do I have to go to an IME?
Yes. Once requested by the employer/insurer, you must submit to an independent medical exam or risk forfeiting your workers' compensation benefits. But remember that the examiner is not your medical advisor. There is no doctor-patient privilege in an IME, so anything you say may become part of the IME record and can be used against you.
Do I have to go alone?
No. You can bring a family member or friend to keep track of what the examining doctor did and what questions were asked. Your doctor or your attorney are allowed to accompany you to the IME, or to help you prepare for the exam.
What if my doctor and the IME doctor disagree?
The IME report may back up your own doctor's assessment, in which the OWC will authorize the prescribed treatment. But it is common for the IME to contradict your doctor's medical opinion or some element of your workers' comp claim. The insurer will try to exploit those differences to cast doubt on your claim. If the OWC sides with the insurance company, your benefits may be reduced or your claim denied altogether.
If you think there may be any issue with your work injury claim, or if the employer has requested an independent medical exam, contact a workers' compensation lawyer. It pays to be proactive, to ensure your medical records are complete and up-to-date, and to prepare for the IME.