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What is an Independent Medical Exam and Do I Have to Agree?

Workers’ compensation claims are one of the most complex areas of law. Insurance companies are often trying to provide as little payment as necessary when they pay workers’ compensation claims. Insurance adjusters may utilize various tactics as they decide to deny or end your benefits. One of the things they may do is request an independent medical exam. If you receive an independent medical exam notice, IME, contact an experienced workers’ compensation attorney in Atlanta. Your attorney will review your situation and answer any questions that you have.

What Is An Independent Medical Examination

An Independent Medical Examination, which is also called an IME, is an examination performed by a non-treating physician at the request of your employer’s workers’ compensation carrier to assess your medical condition.  The Georgia Workers’ Compensation Act permits employers and their workers’ compensation carriers to obtain an IME as long as you are receiving or claiming that you are entitled to receive disability benefits.

Georgia law does not limit the number of IMEs that employers and insurance companies can request, but if you are scheduled for more than one IME every six months, there is a very good chance that your employer’s workers’ compensation carrier is trying to find a reason to suspend your disability benefits.

Refusing an Exam Can Thwart Your Workers’ Compensation Benefits

If the doctor who performs the employee’s exam is biased and favors the interests of the employer, the doctor may try to downplay the severity of the employee’s condition and prematurely release him or her back to work. If your employer is requesting you undergo a medical exam, it’s likely that it is trying to prove you’re capable of work so it can cease your wage replacement benefits. It’s also likely that your employer may be trying to prove that you don’t need surgery or some other type of treatment ordered by your authorized treating physician.

Still, it’s ill-advised to refuse the exam outright. Speak to a lawyer straightaway to discuss your case. If you refuse to be seen for the medical exam, you risk losing your benefits. The laws authorize “the suspension of benefits if the claimant refuses to submit to an employer-requested exam.”

Arguing against the Medical Exam

Claimants and their attorneys have, in the past, tried to justify refusing to submit to an exam on the premise that the doctor was biased and, therefore, not “independent.” This argument doesn’t always hold up because nowhere in the law books does it state that the employer-requested medical exam provider be “independent” – only that the provider be duly qualified.

But there are certain arguments against submitting to an IME that may be viable. Employers must follow certain protocols when it comes to requesting medical evaluations. If the company doesn’t follow the rules, the employee may have just cause not go to the exam. Board Rule 202(b) holds employers to the following responsibilities:

  • The employer/insurer has to give the employee advance notice of the time, date, and place of the IME;
  • The employer must receive the notice at least 10 days prior to the scheduled appointment; and
  • The employer must make advance payment of the travel expenses the worker will incur for going to the exam.

Getting an Independent Medical Exam

independent medical exam for workers comp
An independent medical exam for your workers comp claim is required.

When you receive a request to get an IME you will need to visit the doctor. An IME means that the insurance company will send you to a doctor of their choosing. While these doctors are supposed to be objective, some may be known as being favorable to the insurance company. These biased doctors could make a determination that your injury is not serious, does not require further treatment or that it is not work-related. The findings could result in a redetermination of your benefits or a claim denial. They could report that you are able to return to work under full duty.
Many times the names of these “cooperative” doctors are known to the State Board of Workers’ Compensation. State Board judges are supposed to review cases thoroughly before they make a determination. They will be skeptical of IMEs that are done by questionable doctors. However, if you are denied or your benefits stop as a result of an IME you have the right to a hearing to challenge the findings.

Resolving Improper IME Results

You can and should challenge improper IME results with help from a qualified workers’ compensation lawyer in Atlanta. Your attorney will immediately begin to prepare for a hearing. You will likely need to visit another doctor who is deemed to be unbiased. Your lawyer will work to settle the matter before it goes to court. Questionable reports are common in workers’ compensation matters, so reports need to be reviewed quite methodically.
The IME needs to be reviewed to make sure that it was done properly. Many times the doctor will rush through an exam or will purposely include or exclude details that are important. During the exam you should be sure to note all of your injuries, pain and other problems and request that this information be included in the report. Of course, the report is entirely up to the doctor’s discretion.

Am I Required To Attend An Independent Medical Examination Set Up By The Insurance Company

Yes – as long as the insurance company provides you with proper “notice” of the IME.  If you fail to attend a properly noticed IME, the State Board of Workers’ Compensation may suspend any disability benefits that you are receiving.

Getting Legal Help for your Workers’ Compensation Case

If you receive an IME it is likely a signal that the insurance company is questioning your injuries and a cut-off may be coming. The sooner you talk to a workers’ compensation lawyer the better. If your benefits are denied or are ending, your attorney needs to take action as quickly as possible to ensure that you are properly covered. When you are injured at work, call Bader Scott Injury Lawyers. Our experienced workers’ compensation attorneys are available to review your case, answer your questions and help you keep your benefits. Contact Bader Scott Injury Lawyers today for a free initial case evaluation.

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