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Work Comp Wants An “Independent Medical Examination.” What Should I Expect?

Seriously injured in Alabama? Seek skilled legal advice before seeing insurance doctors. Our firm can help.The weeks and months following a serious work-related accident can be some of the most stressful in your life. One day you are fine. The next, you are hurt and unable to work. Medical treatment, long-term recovery, household bills, and job security, are the most important things in your mind.

Work comp should provide needed medical care without delay. That was the original intent. Yet, the system often fails. Insurance companies and their adjusters ignore doctor requests, fail to return your calls, and work to delay care. You suffer. I hear these complaints about adjusters on a daily basis. You are not alone in your frustration.

Many times, an adjuster or case nurse will suddenly call you out of the blue with an appointment for an “independent medical examination” by some new doctor. They may even tell you the visit is needed to understand treatment options. Don’t forget, the real goal of the insurance company is ALWAYS to save its money.

What is an independent medical examination or IME as it is often called? I’m always reminded of the words another lawyer stated at a conference several years ago — An IME is NOT independent, NOT medical care and certainly NOT a trustworthy examination.

What the insurance company calls an IME is often simply an effort to have a biased company-oriented doctor give an opinion negative to you. Keep in mind that although the adjuster might tell you the visit is mandatory, that is usually not true. If you are seriously hurt and are suddenly facing an IME demand, you probably should talk with a lawyer who understands work comp. By that, I mean a lawyer who will also take a case to court when needed.

When I get calls from injured workers in northern Alabama who are facing an IME, I can usually guess the company doctor who will generate the report. Why? Remember, these IME doctors are not independent. If the adjuster says it’s an “independent” medical examination, that’s almost always untrue. Instead, a small handful of doctors earn a living generating medical reports for work comp and disability insurance companies. The insurance company pays them repeatedly. This very small handful of insurance doctors has an interest in keeping their source of income.

My first advice (as I stated earlier) is you may not have to attend an IME. Call a skilled attorney in your area and ask. If you are facing an IME or go to an IME, what are some common tactics used against you by the insurance company and its paid doctor? How do you handle these tactics? Let’s talk about a few of them.

The Clinic Asks You To Sign Authorizations And Forms.

When you arrive at the doctor’s office, his staff may present you with forms or authorizations allowing them to obtain information about you. They want your signature. They tell you it is just to get some background medical history.

The insurance company already has the information it needs before sending you to the doctor. Most often, these “authorizations” allow the insurance company to go on a fishing expedition through your background. I’ve seen some crazy authorizations that even allow the insurance carrier to get financial information.

What should you do? You should politely refuse to sign the forms. If you are not comfortable with the potential conflict of saying no, then ask to take the forms home for review. You should not sign broad authorizations allowing the insurance carrier to dig unreasonably into your information. Then, talk with legal counsel about the forms before signing.

The Insurance Company Conducts Surveillance. You May Be Watched Or Recorded.

If you have a work comp claim, you need to be aware that insurance companies often conduct surveillance. You may be in visible pain much of the day but it will never be seen on their video. If you are on the ground screaming in pain for 23 straight hours in front of the insurance company’s private investigator, you will still never see any video of it. Instead, and mysteriously, the video will only show the 5 minutes you felt well.

When the insurance carrier schedules an IME, they know exactly where you will be that day. They don’t need an investigator to sit outside your home for days in the hope of catching a couple minutes of video. They know when and where you are going. Their investigator can conduct surveillance on you while you travel to and from the doctor. It’s easy. While you are at the doctor, the clinic and its staff can conduct surveillance on you in the actual clinic. The IME doctor and his/her staff may be watching.

Here is an example — You have a serious low back injury. Sitting, standing and walking are difficult. When you go into the examination room, the doctor may ask how long you can normally sit. Sounds like an important and innocent question. It is an important question. But, in truth, the clinic may have already watched and timed you sitting while you filled out paperwork in the waiting room. You should presume you are being watched. As always, you should be honest during the examination.

The IME Report Minimizes Your Injury, Pain Or Symptoms.

This is very common. The IME report UNDERstates your symptoms and pain. After all, the insurance company wants to minimize the case to make a lower offer. What better way to justify a lower offer than to base it upon a medical report minimizing your problems. Insurance company doctors often minimize your problems by (1) understating what you told them; (2) ignoring problems seen on your physical examination; or, (3) picking and choosing pieces of your past medical records to highlight while ignoring other important parts.

What can you do about this? When you first suffer a serious injury, see a doctor as soon as possible. Then, seek continued care without delay. When the insurance company doctor later does an IME, he or she will not be able to highlight a history of you waiting or delaying care. We hear adjusters in car accident and work comp cases regularly use patient delays or gaps in care to make lowball offers. I’ve discussed the impact of a gap in medical care on an Alabama personal injury claim in prior blog posts. If you have sought consistent medical care before seeing the biased IME doctor, those records can be used in court to attack a bad IME report.

What else can you do? Carry a witness with you to the IME examination. I’ve discussed the value of carrying a friend or relative to medical visits in several prior posts, including one that offered six tips for seeing a doctor after an injury. Make sure the person you take is friendly, reasonable and helpful in seeking/providing information.

The IME Doctor Seeks Admissions That Harm You.

Why is the IME person asking me if I have a lawyer? Why is he asking me if I am planning to sue? That information is not relevant to your medical condition. The insurance company wants the information to help its investigation and to paint you as a litigious person. This is an example of an obvious effort by the IME clinic to seek an admission.

Insurance professionals often approach the issue in more subtle ways. Maybe you had a prior back injury that improved. You had years of good health and good work before suffering your current accident and injury. Yet, somehow, the IME clinic is asking questions to make it sound like you had terrible ongoing back problems before your current accident. Be aware of the questions.

What can you do? Consider taking a witness as I mentioned previously. An attentive friend or relative can help. Consider talking with a skilled attorney before the appointment so you know what to expect. Use clear words with the IME doctor and his staff. Don’t allow the IME clinic to talk you into something that allows them to paint an untrue picture of you. Be clear about your accident. Be clear about the impact or increase the accident had on your pain or problems. Be clear about your pain and symptoms.

The IME Doctor Makes False Statements Or Claims In His Report.

We trust our medical professionals. We should. The vast majority of doctors and nurses have dedicated their lives to helping people. I’m grateful that we have some of the best doctors in the world right here in northern Alabama.

Keep in mind, the handful of insurance IME doctors are not your standard doctors. They are paid to generate reports. They don’t provide treatment. They don’t invest their time and energy in helping you recover. If they were good doctors, they probably would not spend the majority of their time doing quick insurance evaluations.

We want to believe most professionals are honest. Yet, your case is too important for you to simply presume a hand-picked insurance company expert will accurately report the things you do and say. What can you do? I’ll restate that you may not have to attend the IME. If you do go, take a trusted witness.

Some Final Thoughts On The Issue.

An IME can be scary. The insurance company may try to bully or intimidate you into attending one. In comp cases, the insurance company may threaten to stop your temporary total disability (TTD) payments if you don’t attend the IME. The truth — The insurance company likely intends to use the report as justification for stopping payments anyway. Either way, they may be preparing to cut off your benefits.

The insurance company typically wants an IME for one of two reasons. First, they want a justification to make a lowball offer. Second, they may be preparing for a fight. This helps them generate evidence for that fight.

If you are facing an IME request, be prepared. Be honest but be wary of the insurance company’s motives. Seek good advice from an attorney who actually handles your type of case with a track record in the courtroom. Be inclusive of your family or a trusted friend who can witness and advise you during the medical visit.

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At the Blackwell Law Firm, we only handle personal injury claims. We believe in focus. So, we spend all our time working and studying this area of the law. From our office in Huntsville, we represent people with serious injuries across Alabama. Many of our cases include serious car accidents and serious work-related injuries. If you have questions, take a look at our articles or give us a call. We are happy to answer your questions.