If you were injured at work and filed a worker’s compensation claim in Wisconsin, you may receive a request from your employer’s insurance company to undergo an independent medical examination (IME).
This is a classic insurance company defense mechanism that will work against your worker’s comp claim and is usually a sign that your claim will be denied. While you should NOT refuse to participate, you SHOULD hire an attorney to help immediately.
Keep reading to learn more about what to do if you’ve been asked to undergo an independent medical examination.
What is an Independent Medical Examination (IME)?
After you are injured on the job and were treated at a medical facility, you likely requested and submitted to your employer a statement from your doctor. This serves as documented proof of your injury. This is an important and necessary step in filing your worker’s comp claim, but keep in mind that the insurance company is going to do their own digging to verify the facts of your worker’s comp claim.
They will hire their own medical doctor, one that is on their payroll or contracted by the insurance company to complete an “Independent” Medical Examination (IME). An IME is used to determine how much you compensation is due (also sometimes referred to as compensability), the disability caused by the work injury and the proper treatment, as well as if there is any permanent disability or limited earning capacity.
While the physicians performing these exams are board-certified and certainly qualified to practice medicine, they are also being paid by the worker’s comp insurance company to defend them from having to pay the claim. They are trained to look for discrepancies in your story and the previous medical report of your injury and even deflect from the facts using commonly known facts about certain injuries.
For example, if your worker’s comp claim involves a back injury and you go to a chiropractor’s office for your IME, the examiner may point out pre-existing conditions, such as spinal degeneration, smoking, obesity, etc. as reasons the back pain is occurring, not from the work injury.
You may also be asked to participate in more than one IME. In Wisconsin, it is considered reasonable for insurance companies to ask for one IME per six months. However, if your conditions have changed drastically, such as through surgery, then you may be asked to participate in more frequent IMEs.
What happens at an IME?
Like at an annual physical, at an IME, the examiner will review your medical records. You will be asked to detail how your injury occurred. It is important that you keep the details to a minimum and stick to your original story. Changing or adding details can impact the validity of your claim. Be honest at your IME. Your doctor is also watching and reporting on any signs you may be lying or concealing the truth, and any deception or deviation in your story will be documented in the report they submit to the insurance company.
In addition to being asked to recall how your work injury occurred, the examiner will also ask you questions about your symptoms and level of pain.
You may be asked to participate in various nervous system, mental, emotional and behavioral tests to determine motor skills, memory, attention span, etc.
The examiner will evaluate other factors, such as lifestyle, other conditions and ongoing treatment. This is typically the grounds insurance companies try to use to deny your claim. They will use obesity, chronic back pain and other lifestyle and pre-existing medical conditions as the reason for your current pain or injuries. If your claim is not denied, they may use these factors to significantly reduce your compensation amount.
What happens after the IME? How does it impact my claim?
After your IME, the examiner submits a report documenting whether or not you are ready to return to work and at what capacity. This information is then used to determine if and how much your worker’s compensation amount will be.
You can request a copy of this report as soon as it is submitted. Contact your long-term disability insurance provider for a copy. Please note, if they sent the IME report to your treating doctor for verification, they may require you to get a copy directly from your doctor.
After the IME report is submitted, the insurance company then continues its fact-finding efforts, which may include a vocational exam, functional capacity exam or medical file review.
An IME can have a big impact on your disability or worker’s comp claim, as it is used by WC judges or hearing officers as evidence. It is important for you and your worker’s comp lawyer to thoroughly review the report for accuracy prior to the hearing. You and your attorney can compile additional evidence that supports your claim or refutes “facts” in the IME.
Do I have to participate in an IME?
Since IMEs can have negative impacts on disability and worker’s comp claims, it can be tempting to try to avoid them altogether. Keep in mind that if you are summoned to participate in an IME, you need to do it.
Here are some steps to take so your IME to has a limited impact on your case:
Be polite and tell the truth. In addition to the details of your injury, the medical examiner is also including your demeanor and how forthcoming you are in their report. As a reminder, do not exaggerate or lie.
Prepare for your IME. Review your medical history, outline the details of your workplace accident, think through how the pain from your injuries impact your day-to-day activities and prepare a list of medications you now take. This is especially helpful if you get nervous for normal doctor appointments (white coat syndrome), and have trouble formulating your thoughts on the spot. Having all this information ready will help you provide accurate information, as well as give you much needed confidence during your IME.
Don’t make small talk. Be friendly, respectful and answer the questions you are asked, but don’t add in anecdotal stories or “trash talk” your employer. These additional details could work against you.
When should I talk to an attorney?
It’s best to talk to a disability or worker’s compensation lawyer BEFORE you participate in an IME.
By contacting the attorneys at Di Renzo & Bomier before your exam, we can help prep you for some of the questions you might be asked and the ways in which you can answer honestly that accurately reflect your injuries.
If you have already participated in an IME, we can still help you. Call us for a free consultation to talk through what the next stages of your worker’s compensation claim might look like.
As a reminder, we don’t get paid unless you do, so if you are worried about the cost of working with a worker’s compensation, don’t be! We offer a free consultation about your disability or worker’s compensation claim—just tell us a little about your case so we can prepare for our consult.
Let us do the heavy lifting for your worker's comp claim.
Being injured on the job can be overwhelming. If you or a loved one have been injured on the job, Di Renzo & Bomier offers a free, no obligation consultation to discuss your case. Call (800) 725-8464 or fill out our online form to schedule an appointment.
We represent injured workers in Neenah, Appleton, Green Bay and across Northeast Wisconsin.
The content of this blog was prepared by Law Offices of Di Renzo & Bomier, LLC for educational and informational purposes only. It is not intended to solicit business or provide legal advice. Laws differ by jurisdiction, and the information in this blog may not apply to you. You should seek the assistance of an attorney licensed to practice in your state before taking any action. Using this blog site does not create an attorney-client relationship between you and Law Offices of Di Renzo & Bomier, LLC.