If an Independent Medical Evaluation has been scheduled for an injured worker there are a number of things for which he or she should be prepared.
For starters, it is helpful to know what exactly is an IME. Knowing why the exam was scheduled will help the injured worker prepare for the examination and comprehend what could happen after the IME is performed. The below information is directed toward Independent Medical Evaluations as they are performed in Maryland. Each state has different administrative rules regarding IME’s and subtle differences can have a significant impact on each case.
Posting is for information purposes only and should not be mistaken for formal legal advise. Every case is different!
For a no cost consultation with Maryland Injury Attorney Andrew M. Rodabaugh call +1 (410) 937-1659 ,or Email .
Understanding an Independent Medical Evaluation
IME’s are evaluations scheduled by the workers compensation insurance adjuster with a doctor in a applicable field of medicine. This may be with an orthopedic, pain management physician, internal medicine, or psychiatrist. The IME doctors are methodically selected well in advance of the accident because often their medical opinions can be predicted ahead of the appointment. Some IME opinions are predicted to be fair and completely impartial. More often the opinions are partial and in favor of workers comp. This is to say there are a number of IME doctors that are used by workers compensation insurance companies because the insurance company expects and hopes for the doctor to indicate a particular medical opinion in their report.
- The pain is due to arthritis and not the accident at work,
- The need for medical treatment is related to arthritis or degeneration,
- The injured worker is capable of working in full capacity,
- The treatment prescribed is not reasonable,
- The treatment prescribed is not necessary,
- The injured worker can work in light duty capacity,
- No further treatment is needed as a result of the accident,
- The complaints by the injured worker are magnified and do not match up with the medical findings,
- There is no need for surgery,
- There is no need for physical therapy,
- There is no need for an MRI,
- The need for medical treatment is related to a prior accident.
It is not unusual for workers comp insurers to pay thousands of dollars for these opinions. Some Independent Medical Evaluation doctors may charge in the range of $3,000 to $5,000 for an opinion. Ordinarily they range from $300 to $1,500. A physician charging $300 for an IME could conceivably perform 8 IME’s daily if they were to spend 1 hour on each exam, 40 per week, 160 a month, 1,920 annually. Many of theses physicians do not perform 8 evaluations daily because they also have a practice which requires treating patients daily.
For the insurance company to challenge medical treatment, or paying compensation they need a medical opinion in support of their opinion. An expert opinion. The purpose of these evaluations are almost always to provide workers comp the ability to terminate medical treatment and stop paying. If an IME is scheduled by the adjuster, or a nurse case manager, they likely want to end the case. Occasionally these evaluations are scheduled by the adjuster or nurse case manager at the request of the injured worker.
If an injured worker wants a second opinion and asks the adjuster for the same, most often an IME doctor will handle the “second opinion.” IME doctors should not ordinarily be used for second opinions. And if this is suggested then a consultation with an experienced workers compensation attorney should immediately be sought.
Under current Maryland Workers Compensation Laws the workers comp insurer has the right to schedule an independent medical evaluation. As long as the location, and time are reasonable the injured worker is expected to attend. Not only is the injured worker expected to attend the evaluation but must attend by law.
Who performs Independent Medical Evaluations
These evaluations are performed by a number of different types of doctors throughout the state of Maryland. The particular doctor performing the evaluation must comply with the American Medical Association guidelines. That said there are only a number of doctors in the state that are qualified or willing to perform an IME. A list of some doctors used to perform IME’s by workers comp can be found here. Among the type of doctors that perform the evaluations are orthopedic surgeons, neurologists, neurosurgeons, physiatrists, pain management doctors, internest/internal medicine doctors, psychologists, and psychiatrists.
Each independent medical evaluator has their own style of performing the examination. Some may immediately give off the impression that they are working for the insurance company. For these evaluations questions both relevant and irrelevant will begin at the very beginning of the evaluation. It has been said some of these evaluations provide a way for the insurance company to gain information to use adversely to the injured worker. The IME doctor may perform somewhat of an investigative role. Other IME physicians may exhibit perfect bedside manner and perform the evaluation in both a professional and helpful manner.
Without an extensive consultation with a workers compensation attorney it is difficult to predict the results of the evaluation because other factors may contribute to the expected opinion such as the injured workers demeanor, facts of the case, history of the injured workers health, and nature of the injury.
IME’s do not create a patient/doctor relationship
Injured workers often attend independent medical evaluations mistakenly thinking they are attending “just another doctors appointment.” This is not the case. IME’s should not be viewed as just “another docctors appointment,” nor should they be viewed as a second opinion. There is no patient/doctor relationship so there is no obligation to treat the injured worker. It can be further argued that any advise the physician provides to the patient is not medical advice. Arguably, if there is no obligation to treat then there is no chance of medical malpractice and no chance of ethical or moral violations.
I have been told by a number of clients the IME doctor made off the record statements and I only later find out writing in the report was contrary to what was verbally indicated. If the inconsistencies are true then perhaps it reflects effort by the particular physician to encourage treatment even though the written report will indicate otherwise.
For a no cost consultation with Maryland Injury Attorney Andrew M. Rodabaugh
call +1 (410) 937-1659 ,or Email .
Preparing for an Independent Medical Evaluation
Failure to prepare in some degree for the IME may lead to less favorable results or even the end of medical treatment and compensation. In some circumstances no amount of preparation is going to change the expected result of the physician however an effort should still be made to attempt to lean the examination in favor of the injured worker.
IME doctors are human and therefore are vulnerable to being influenced, but also, particularly for IME purposes, can be judgemental. This means that the injured worker should put on their best manners, be personable, likeable, and friendly. Even if they want to act differently!
- Make sure to show up to the appointment on time. Not only can the appointment be cancelled if the injured worker is late, but the insurance company can request and possibly obtain reimbursement for the appointment in the amount of $125.00.
- Again, these doctors can be influenced. Some more so than others. The injured worker should be friendly, non-hostile, and likeable. While it may be tempting to be rude, hostile and non responsive it is often in the injured workers best interest to “bite their tongue” and understand that more damage than good will come out of acting on emotion. Further, be pleasant to office staff at the physicians office. Perhaps staff members are most influential people in the doctors life and certainly would not hurt to have a staff member indicate how pleasant and frenziedly the attendee was.
- Dress appropriately. The cloths a person wears can reveal much about their personality from a sociological standpoint but also from a medicinal standpoint. A person dressed in “thug” wear may be viewed as a thug and therefore lead to an IME indicating they are gaming the workers comp system and are not truly injured. A person who generally lacks in the area of hygiene and shows up to an IME in dirty clothing may influence the examiner to find pre-existing medical conditions.
- Honesty is the best policy. IME doctors often already know the answers to the question they will be asking. One example is their inquiry as to prior accidents. This could be work related, auto related or otherwise. Unless 100% certain there have been no prior accidents it is likely best to indicate lack of knowledge or memory of any accidents. Likewise, inquiries as to injuries should be carefully answered. If there is any reason to believe the injured worker is dishonest the physician will indicate so.
- Prepare for surveillance. Surveillance is often dispatched when the injured worker is attending an IME because workers comp knows the injured worker will be leaving their home at a certain time and they know where the injured worker will be at the time of the IME. This is ideal for video footage because it can capture behavior both before and after the IME which may be inconsistent. Take for example the injured worker that shows up to the IME with a cane, and upon leaving the IME has no use of the cane. For more on surveillance go here.
What the injured Maryland worker should expect at the IME
There may be a wait. A long wait. Not only is the injured worker aggravated because they have to attend the IME appointment to see a doctor who will question whether they are actually injured, they may have to wait an hour or more to see this doctor they didn’t want to see in the first place. Compounding the frustration is a lawyer who may have advised the injured worker to be friendly and honest to the doctor. IME’s can be a very frustrating experience or they can be mildly inconvenient.
The physician will review medical documentation they have in their possession prior to or after the examination to have a better grasp of the injury and treatment obtained. Review of medical records may take as long as necessary depending on the volume however the injured worker may not necessarily witness medical record review. In addition to medical records being sent to the IME doctor, other evidence the defense attorney plans to use may be sent to the doctor for review. This could include surveillance, insurance records from prior accidents, injuries, or treatment such as auto insurance records or primary care records. If an accident occurred over 20 years prior the workers comp adjuster and the IME doctor may know about it.
The physical examination length will vary depending on many factors but each IME doctor has their particular style and procedures. Some physical examinations will be less than five minutes while others will be an hour or greater. Some examinations will entail checking the range of motion of multiple joints, while other examinations will include no physical contact at all. During the evaluation the physician may ask many questions or no questions at all.
As I stated earlier some IME doctors act as a quasi investigator for the workers comp insurer. They ask questions in hopes to catch the injured worker in a lie, or inquire as to facts that may justify an unfavorable medical opinion. Alternatively, there are IME doctors that do very little to no talking during the examination. Perhaps this is just a personality characteristic, or perhaps the near silence is to avoid conversation and the vulnerability to influence. In either case the injured worker should discuss the particular IME doctor with a qualified and experienced attorney prior to the examination so they may be better prepared.
Post Independent Medical Evaluation expectations
IME’s are scheduled for a number of reasons in workers compensation cases so each report may only address the relevant and applicable issues. Most often IME’s are scheduled to address the necessity, reasonableness, and causal relationship of medical treatment. The report therefore could mean that further medical treatment will continue to be denied until a hearing at the Maryland Workers Compensation Commission (MWCC) is held, or if the IME doctor issues a favorable opinion the medical treatment may then be approved and there will be no need for a hearing.
The workers comp insurer may also schedule one of these evaluations with the hope that the physician performing the examination finds a work capacity different than that of the treating doctor. This would give workers comp the ability to stop the weekly temporary total disability checks and necessitate a hearing to get those checks reinstated. Or in the alternative this would force the injured worker to immediately have to return to work despite their physical condition.