What if an Independent Medical Examination Doctor Doesn’t Agree with My Doctor?

IME doctorToday’s wise words come to us from my colleague Roger Moore of Nebraska.

As I have written previously,  in Nebraska, you have the right to choose your family doctor to treat you for your work injury.  For purposes of the workers’ compensation court, that person becomes your “treating doctor.”  However, sometimes an employer or insurance provider selects a non-treating doctor for an “independent medical examination” (IME). According to the workers’ group National Association of Injured & Disabled Workers (NAIDW), IMEs are used for three reasons:

  1. “to determine the cause, extent and medical treatment of a work-related or other injury where liability is at issue”
  2. “whether an individual has reached maximum benefit from treatment”
  3. “whether any permanent impairment remains after treatment”

When an IME is scheduled, this probably means your employer or the insurance company is trying to fight some aspect of your workers’ compensation benefits.  An IME doctor frequently bases his or her findings on what is often a very brief visit with a patient.  Sometimes they don’t even perform a physical examination before rendering their opinion.  Rarely do they issue opinions that are favorable to an injured worker.  For that reason, when an examination like this is scheduled, my policy is to file a Petition with the Court if one is not already on file.  The IME doctors can recommend medical treatment, but should not render that treatment because they are not the workers’ treating doctor and therefore do not have a “doctor/therapist-patient relationship.” If you allow them to perform medical treatment, you may have unwittingly transferred your medical care to this hired gun.

Ultimately it’s up to the Nebraska Workers’ Compensation Court (or an arbiter or court in your particular state) to determine which doctor’s opinion is more credible.

When an IME is scheduled, your attorney can be your advocate.  If you don’t have an attorney when the exam is scheduled, you should at least consult with one before attending the IME.  It’s important to ensure the IME doctor has all the relevant records before forming opinions, took a valid history, and is qualified in the medical specialty at issue.  It’s also important to contrast the findings of the IME doctor against the findings of the treating doctor.  Ultimately, it’s up to the Nebraska Workers’ Compensation Court (or an arbiter or court in your particular state) to determine which doctor’s opinion is more credible.  Often your attorney will find that the IME doctor’s practice is largely based on doing these cursory exams, which creates a bias to report findings that the insurance companies will like, often mischaracterizing the medical notes or the injured worker’s history.

Be sure to prepare for your IME with your attorney.  You should go into the appointment with the understanding that every word you use may be used against you if the opportunity presents itself.  It may be that no matter what you say the doctor has already made up his or her mind.  However, even if you do not agree with the IME doctor, you should not confront or argue with them. Let your lawyer do that in court, where it matters.

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