Insurance Medical Examinations and Their Effect on a PA Workers’ Compensation Claim
If you’ve been hurt on the job in Pennsylvania, you’re probably aware that workers’ compensation benefits are available to help you recover, both physically and financially. But what happens if you’re asked to undergo an insurance medical examination (IME) as part of your workers’ compensation case? The idea of having a doctor who doesn’t know you assess your injury can feel strange and uncomfortable. If you’ve never had to deal with one before, you may wonder, “How is this different from seeing my regular doctor? What does this mean for my case?”
Knowing the IME’s procedure is crucial. If you’re asking whether a workers’ compensation lawyer can help you through that process, the answer is yes. Let us dissect it methodically and consider how an IME might influence your case.
What’s an IME, and why does it matter?
An insurance medical examination (IME) is a review conducted by an insurance company-hired doctor. Insurance companies refer to these exams as Independent Medical Exams, however there is nothing independent about these exams as the insurance doctor is not there to treat you or help with your claim.
In theory, it should be impartial. The problem is that the doctor who performs the IME is usually chosen by the insurance company, and it’s in their best interest for the IME to support their position. It’s important to realize that “independent” doesn’t always mean neutral. The doctor is often a specialist who has been hired by the insurance company for one reason: to assess the case in a way that benefits the company.
Common scenarios when IMEs are ordered:
- The insurance company disagrees with your doctor.
- They think you’ve recovered.
- They want evidence to stop or reduce your benefits.
In Pennsylvania, you’re required to attend an IME if the insurance company requests it. Refusing to go can lead to complications, like the suspension of your benefits. But even though it’s required, it’s important to understand that the IME could influence your claim in ways that work against you.
How does an IME impact your workers’ compensation case?
The results of an IME can significantly impact your workers’ compensation case in Pennsylvania. Here’s why:
- The doctor’s opinion: When you see your regular doctor, they know your medical history and the progress of your treatment. The IME doctor, however, doesn’t have that same level of familiarity. They’ll rely on medical records and a quick examination to assess your injury. If they don’t agree with your regularly treating doctor’s opinion, it could create a problem for you.
- Your benefits may be affected: If the IME doctor concludes that you’re able to return to work before your own doctor agrees, or if they downplay the severity of your injury, the insurance company might use that report to deny or reduce your benefits. They might argue that you’re not as injured as you claim or that you’re capable of returning to your previous job.
- Disputes are challenging: In Pennsylvania, workers’ compensation law is designed to provide you with benefits for work-related injuries. However, if the IME doctor’s report contradicts your treating physician’s opinion, you might find yourself in a difficult situation. The insurance company might base its decision to stop or reduce your benefits on the IME report. It’s frustrating, but remember, you have the right to challenge the findings if they seem unfair or inaccurate.
The IME process: What to expect
You might be thinking, “Okay, I get it, but what actually happens during the IME?” Here’s what you can expect if you’re asked to attend one:
- Scheduling the appointment: The insurance company will schedule the IME, and they’ll usually give you advance notice. They may also provide you with a list of doctors to choose from, but these doctors will likely be ones the insurance company uses regularly for these exams.
- The examination: On the day of your IME, you’ll be asked to meet with the doctor. They will review your medical records and may ask you about your injury. Expect to answer questions about your symptoms, your treatment plan, and how the injury has affected your life. It’s important to be honest but keep things straightforward. Don’t overexplain or exaggerate, but don’t downplay your injury either.
- The report: After the exam, the IME doctor will submit a report to the insurance company. This report can make or break your claim. It will outline the doctor’s findings, including your injury, recovery prospects, and whether you can return to work. The insurance company will use this report to make decisions about your benefits, so it’s crucial to understand the impact this document can have.
What if the IME report doesn’t match your treating doctor’s opinion?
Often, the findings from the IME doctor might not match what your treating physician has said. For example, your regular doctor might say that you need more time off work or that you should continue with your current treatment plan, but the IME doctor might say you’re good to go back to work. This discrepancy can put you in a tough spot.
In Pennsylvania, if the IME report doesn’t align with your treating physician’s opinion, you can challenge it. But it’s not always easy. The insurance company may initially side with the IME doctor’s opinion, and you might have to go through legal proceedings to have your case heard. This is where having an experienced workers’ compensation lawyer on your side can make all the difference.
Why you should contact a workers’ compensation lawyer
If you’re facing an IME or dealing with a situation where the IME report isn’t in your favor, it’s a good idea to speak with a workers’ compensation lawyer. A lawyer can help you understand your rights and ensure that you don’t get taken advantage of by the insurance company.
Here’s why you should get a lawyer involved:
- Expert guidance: A workers’ compensation lawyer can help you prepare for the IME and guide you on what to expect. They can also review the IME report and advise you on your next steps if the results aren’t favorable.
- Disputing the IME: If the IME doctor’s report doesn’t reflect your true condition, a lawyer can help you challenge it in court. They can help you gather the necessary evidence to counter the IME report and fight for your benefits.
- Protecting your benefits: If your benefits are reduced or cut off because of the IME, a lawyer can help you fight to have them reinstated. They work to ensure that the insurance company doesn’t take advantage of the situation.
IMEs are serious — but you don’t have to face them alone
An insurance medical examination (IME) can be a nerve-wracking part of the workers’ compensation process, especially if the results are used to undermine your case. But you don’t have to go through it alone. A skilled workers’ compensation lawyer can help you navigate the complexities of the system, challenge unfavorable IME results, and fight for the benefits you deserve.
At Carmody and Ging, Injury & Accident Lawyers, we’ve been fighting for injured workers throughout Pennsylvania for more than 30 years. If you’ve been asked to attend an IME or if you’re struggling with a workers’ compensation claim, don’t hesitate to reach out for a free consultation. Our experienced team will work to protect your rights and help you get the compensation you need to recover.
Contact us today, and let us take care of the legal details while you focus on getting back to health.