If you were injured on the job, you may be working your way through a workers’ compensation claim. After you file your claim to pursue benefits, you may face complicated requests, such as an Independent Medical Exam (IME).
Below, a workplace injury lawyer from Pyrros, Serres & Rupwani discusses what an IME is, the implications of this request, and how to prepare yourself for the evaluation. For more information or to discuss specific details relating to your case, consider consulting a workers’ compensation attorney in New York.
What Is an Independent Medical Exam (IME)?
If you are hurt at work, the first step is typically to file an injury report with your employer. You should seek emergency care or visit a primary provider within the first 48 hours.
Your provider will fill out the Doctor’s Initial Report on form C-4 and submit it to the New York State Workers’ Compensation District Office. When the New York Workers’ Compensation Board receives this form medical report and the notification of a claim from your employer, a case will be assembled.
Upon officially filing your claim, your employer’s insurance may accept it, or they may order specific requests, such as an Independent Medical Examination. This is an additional medical assessment conducted by a provider in the insurer’s chosen network. But why might an IME be ordered?
Medically payments for workers’ compensation claims can be costly for insurance providers. According to the NCCI’s Workers Compensation Statistical Plan database, some of the leading costly injuries are amputations, averaging $120,077 per claim, burns, costing an average $67,224 per claim, and fractures, crushes, or dislocations, averaging $63,531. Even seemingly simple sprains or strains averaged $35,675 in indemnity and medical costs per workers’ compensation claim between 2021 and 2022, highlighting the financial ramifications of workplace injuries.
With employers reporting millions of illness and injury cases per year, it’s not uncommon for insurers to question the nature of alleged injuries. Even if you’ve already been seen, treated, and officially diagnosed by your provider, your employer’s workers’ comp insurer may request an additional examination to confirm this assessment and your need for ongoing medical care. With an IME, the insurance carrier selects a doctor of their choosing to complete the exam.
When Might an IME Be Ordered?
IMEs are typically ordered to dispute an aspect of a workers’ compensation claim. To put it simply, an IME may act as the insurance company’s “second opinion.” These exams may be ordered if the insurance company is unsure of the following:
- Whether the injuries are as severe as stated
- Whether the workplace accident directly caused the injuries
- Whether the injuries prevent the claimant from working
- When maximum medical improvement will be reached
- Whether future treatments will be required
- Whether the current treatments are necessary
- Whether the injuries are related to a pre-existing condition
- Whether surgery is necessary
These are just a few examples of questions insurance companies may ask about a claim. The IME physician will conduct an exam and report their findings to the insurer. Your options for challenging these findings are generally limited, but legal options do exist to challenge the opinion of the IME.
If concerns arise from your IME, consider consulting a workplace injury lawyer.
Are IMEs Required If Ordered?
Yes, if a workers’ compensation insurance provider orders an IME, you’re generally required to attend the exam to continue your claim. You still maintain a few key rights here:
- The right to video record the examination
- The right to bring an individual(s) of your choosing to the visit
- The right to reimbursement for your travel expenses from the insurance company
Should You Be Concerned If an Insurance Company Orders an IME? A Lawyer for Workplace Injuries Explains the Implications
IMEs are generally ordered when the insurance company disagrees with a certain aspect of the original claim, or the need for ongoing treatment/surgery.
IME physicians are expected to provide independent and objective assessments. But, insurance companies typically hire doctors who give them favorable findings. This does not mean that all IME providers are biased to the insurance company, but many of them have an incentive to give a finding that’s more favorable to the insurer.
Because of this, IME orders may warrant concern, particularly when your injuries constitute extensive medical treatments or long-term time off from work. You may consider seeking legal representation from a workplace injury lawyer if your employer’s insurer orders an IME.
What To Expect During Your Independent Medical Exam
IMEs operate a bit differently than standard doctor visits, as the physician will be primarily focused on the extent of your work-related injury and your ability to return to work. To do so, they will evaluate factors such as:
- Your overall appearance: The physician considers everything down to the way you walk into the exam room & how you’re dressed. For example, if you have a broken ankle, you may be expected to not be wearing high heels.
- Any potential inconsistencies: IME doctors may attempt to find discrepancies in your claim. The symptoms you describe to this provider should match the ones for your diagnosed injury. They may look to see whether you’re limping or if you wince in pain from certain movements.
- Your medical records: The IME provider will spend time evaluating your history and documentation, looking at things like imaging findings, to determine whether your initial provider came to the right conclusion based on sufficient medical evidence.
- Your responses to physical tests: They will perform their own series of physical exams to better understand the nature of your injury, your mobility, and whether you’re able to perform certain work-related tasks. They will even note how to get on/off the examination table.
Preparing for Your IME
You can take a few steps to prepare for your IME to ensure you’re well informed and ready for the process. Insurance companies typically communicate with IME doctors in advance, so we recommend requesting a copy of this correspondence to understand what the doctor does or does not know.
Before the exam, spend time jotting down all accident and injury details to refresh your memory. This will help you have your facts straight, ensuring consistent answers during the appointment. You should review your medical records to familiarize yourself with the documentation that the provider will be viewing.
Be polite during the exam, answer all questions honestly and accurately, but avoid exaggerating or offering up more information than necessary.
Are You Looking for a Workers’ Compensation Attorney in New York?
Now that you understand what an IME is, learn about common mistakes in workers’ comp claims. If you’re looking for a workplace injury lawyer to help you pursue disability benefits, contact Pyrros, Serres & Rupwani today at (718) 626-7730 to discuss your case.
FAQs Answered by a Workers’ Compensation Lawyer in New York
Preparing for an IME can be stressful. Find answers to more common questions below:
What Should You Avoid Saying During an IME?
You should avoid lying, exaggerating your symptoms, or speaking negatively of your employer during an IME. Give direct, truthful answers, but avoid volunteering excess details. While you may be tempted to, do not ask the provider for their diagnosis.
Can You Refuse To Undergo an IME?
IMEs are typically required under New York law. While you can technically refuse to attend an IME, doing so will likely result in suspension or denial of your workers’ compensation claim. In limited insurances you may be excused from attending the IME for good cause such as illness, or even a documented family emergency.
