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“Independent” Medical Examinations? Only In Name…

Anybody who has ever been in the workers’ compensation system has heard the phrase “independent medical examination,” or “IME.” An IME is an examination requested by an insurance company to be performed on an injured worker by a doctor who has never treated the injured worker before, is hand-picked by the insurance company and is paid for the examination by the insurance company. Webster’s Dictionary defines “independent” as “not subject to control by others,” or “not affiliated with a larger controlling unit.” Trying to reconcile the definition of “independent” with the concept of an independent medical examination, however, is fruitless.

As part of a workers’ compensation claim, an injured party, or claimant, can have the best doctors around diagnose their injury as work-related. But, when the insurance company decides that it is tired of paying wage loss and medical benefits to the claimant, or wants to avoid paying the claimant altogether, it hires a suitable doctor to perform an examination on the claimant. Many times, these doctors are not local, so the claimant must be shipped several hours away to meet with the chosen one. Then, after a single appointment, usually lasting anywhere between 10 and 45 minutes, low and behold, the insurance company’s doctor has a different opinion than the claimant’s treating doctor.

For instance, while the treating doctor is still seeing the claimant for their ongoing symptoms and has them disabled from working, miraculously, the defense medical doctor says that the claimant is fully recovered from the work injury and can return to work, unrestricted. Or, while the claimant’s treating doctor, who has seen them for months and been with them from day one, clearly states that their condition is work-related, the insurance company’s doctor, after a 15-minute examination/history taking/review of the records, deems the claimant’s condition to be pre-existing.

As crazy as this sounds, this is exactly what happens on a daily basis in the workers’ compensation system. The law allows insurance companies, at certain stages of the claim, to force a claimant to submit to such an examination. But, with death of the concept of giving the injured worker the benefit of the doubt, which happened a long time ago, insurance companies spare no expense in finding the “right” doctor to conduct these examinations. In my career, I have cross examined hundreds of defense medical examiners. Some of these “experts” perform over 10 examinations for insurance companies a week, at a rate of several thousand dollars an exam. Playing out the math in these situations reveals that these doctors can earn well over $1,000,000.00 a year in this business. In fact, I have come across many defense medical examiners who essentially no longer practice medicine, because it is more lucrative to be the go-to doctor for insurance companies than to see regular patients in a traditional office.

As an attorney who only represents injured workers (and those hurt in motor vehicle or other accidents), having handles thousands of workers’ compensation claims, I can say that, when the insurance company schedules an IME, it is a watershed moment in the claim. If you are an unrepresented claimant and this happens, it is time to speak with an attorney; because, “independent” does not mean independent.

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