When you file a workers’ compensation claim after a work-related injury, you may be asked by your employer’s workers’ compensation insurance carrier to undergo an Independent Medical Examination (IME). An IME can have a significant impact on the outcome of your workers’ compensation claim. Therefore, before going in, it’s important to understand what an IME is, how to prepare for it, and how to conduct yourself during it.
What Is an IME?
The first step in the workers’ compensation application process is to notify your employer of the injury. If that is not possible due to the severity of your injuries, seek medical care immediately, but inform your employer of the injury within 30 days. Regardless of when you seek medical treatment, the treating doctor will compile a medical report and submit it to the New York State Workers’ Compensation Board. After you officially file a claim, your employer’s workers’ compensation insurance carrier may then request that you undergo an IME — even if you have already been seen and treated by your own doctor — to further assess your injuries. A doctor chosen by the insurance carrier will perform the exam.
Should You Be Worried About an IME?
In most cases, insurance companies order IMEs because they disagree with the original treating physician’s findings, particularly if those findings indicate that you need extensive medical treatments and will not be able to work for a while. Many workers’ compensation applicants suspect that the doctor performing their IME will not be totally “independent.” This is not entirely untrue, as IMEs are a lucrative source of revenue for doctors, and many are keen to be re-hired by insurance companies after delivering favorable results. Insurance companies are also known for shopping around for doctors who frequently give them the results they want. While not all IME doctors are biased, understand that the doctor performing yours has an incentive to interpret the results in the light most favorable to the insurance company — not to you.
What to Expect at Your IME
An IME is different from a traditional medical examination. The doctor conducting the IME likely is an expert on workers’ compensation cases and work-related injuries and will be much more narrowly focused on determining the extent of your work injury and assessing whether and when you can return to work. Also, keep in mind that an IME does not give rise to a doctor-patient relationship or any type of confidentiality, so you can expect the doctor to relay everything you say back to the insurance company.
What Do Doctors Look For During IMEs?
The doctor conducting your IME will be looking at several factors during the exemption, such as:
Your Overall Appearance
The doctor will be paying attention to whether your overall appearance — including the clothes you are wearing — is consistent with the injuries you claim. For example, if you have an injured ankle, the doctor will be expecting you to show up in a cast, not high heels. If you have injured your arm, the doctor will expect you to be in a sling. If you have injured your leg, the doctor will expect you to be on crutches. IME doctors look for whether the people they are examining “look the part.”
Signs of Deception and Inconsistencies
IME doctors are experts at sniffing out deception and spotting inconsistencies that may harm your workers’ compensation claim. Did you have a limp when you walked in? Did you still have the same limp when walking to your car after the appointment? Did you grimace in pain at any point, and did it seem genuine? Do your current symptoms match what you told your own doctor previously, and are they the type of symptoms that would be expected for the condition you are alleging? Do any of your physical ailments directly affect your ability to be able to perform your job? Generally, the IME doctor will be looking for consistency and assessing whether you are being truthful about your injuries.
Your Medical Records
Expect your IME doctor to comb through your medical records, including test results, x-rays, CT scans, MRIs, prescription medications, and others, to determine whether there is any objective medical evidence of your condition. He or she will also be looking for mistakes in your initial medical evaluation or whether your own doctor made conclusions that were unsupported by the evidence. IME doctors — and the Social Security Administration (SSA), for that matter — put more stock in objective medical evidence than self-reported descriptions of symptoms. While self-reported symptoms can form a partial basis for a workers’ compensation claim, they will only help your case if they are consistent with objective medical evidence.
Your Responses to Physical Tests
An IME doctor will likely perform a series of tests on you to determine the nature, severity, and extent of your symptoms. He or she may also ask you to try to do certain tasks to see how well you perform. For example, if you claim that a back injury prevents you from working, the doctor may ask you to bend over and try to pick up a pen off the floor. If you are alleging a loss of eyesight, he or she may ask you to read letters off of a vision chart. The doctor will be assessing how well you perform or respond to these tests, as well as whether your pain or other symptoms of your condition are indeed severe enough to prevent you from working.
What to Do Before the Exam
There are several steps you can take to minimize the risk that an IME will sink your workers’ compensation claim. The most important thing to remember, as mentioned above, is that your IME doctor is not on your side; assume that he or she is skeptical of your claims and will be digging to find evidence that could undermine them. With that in mind, here’s how you should prepare for an IME:
- Figure out what the insurance company has told the IME doctor. Insurance companies usually communicate with IME doctors ahead of the examination in the form of a report that outlines your case and asks the doctor to examine certain aspects of your claims. Ask to receive a copy of this letter ahead of time to get a general idea of what the IME doctor will be checking.
- Get your facts straight. The IME doctor will ask you deep, probing questions about your accident and likely will want you to go into every little detail. Write down everything you remember in chronological order and study it ahead of the exam. Also, make sure that what you plan to tell the IME doctor is consistent with what you’ve said previously.
- Review your medical records. Familiarize yourself with your medical history. IME doctors will be looking for any previous injuries or pre-existing conditions that could be responsible for your present condition, so be prepared to explain how your current condition differs. Also, review the course of treatment you have undergone for your present injury and how well you responded to the treatments.
What to Do During the Exam
Your IME doctor will be meticulously watching your behavior and recording everything you say during the exam. Below are a few tips to make the best impression.
- Be polite. Your IME doctor may not be on your side, but you should still treat him or her with cordialness and respect. Hostility or rudeness cannot help your claim; it can only hurt it. Also, avoid anger and outbursts if you feel that the examination is not going as well as you had hoped.
- Tell the truth. Do not exaggerate the extent of your injury, and definitely do not lie about any of your symptoms. IME doctors are experts at detecting deception and inconsistencies and will almost certainly be able to tell if you are being dishonest. Documented lies or exaggerations can seriously harm your claim.
- Answer only what is asked of you. Give simple, straightforward answers to the doctor’s questions and do not volunteer any extra information, as you could inadvertently say something that could harm your claim by doing so. If possible, give “yes” and “no” answers. Also, avoid being too chatty with the doctor or discussing anything personal.
What to Do After the Exam
After the exam, write down everything you remember — what the doctor asked you, how you answered the questions, the tests he or she performed on you, how you did on the tests, etc. Once the doctor has fully assessed your condition, he or she will provide a report to the insurance company, of which you and your attorney should request a copy. If there are errors or conclusions not supported by evidence in the report, your attorney may be able to file objections or seek a deposition to interrogate the doctor who performed the IME. If you do not have an attorney, now would be an ideal time to hire one.