In this post we have compiled a few frequently asked questions we receive from injured workers with regards to independent medical examinations (IME). These include: Can an IME judge you or down you in his/her report; Can an IME opinion override the medical opinion of your doctor?
Independent Medical Examinations: Frequently asked questions
Fact: the IME has no doctor-patient relationship with an injured worker, so he can say whatever he wants in his report to the workcover insurance. But, don’t panic, the more the (biased) IME states in his/her report that is beyond the medical facts, the less believable his/her whole report becomes, especially should the matter proceed to court (it is not the first time that certain well-known biased IMEs have been laughed out of Courts).
Some lawyers relish cases where the IME doctor wrote all kinds of medically irrelevant BS (bullsh*t) in the report, and made personal judgments about the injured worker. If—for example—an IME judges an injured worker based on their tattoos, it clearly implies that s/he did not judge you based on your medical condition, and that is good for you (the injured worker)!
Can the IME do it? Yes! The IME is allowed, and even required, to state his/her conclusions in the particular injured worker’s case. However, the unprofessional things the IME did (or example nasty or inappropriate remarks made about an injured worker’s tattoos) make it reasonably likely that the IME’s conclusions will not carry much weight with the trier of fact. For example, a tattoo has no bearing whatsoever on whether the injured worker needs pain medication (vs being automatically labelled as drug-addict).
Dismissive conclusions from a 5-15 minute diagnosis mean little. If an injured worker has a drug history, s/he should of course not take narcotics (unless prescribed by a pain specialist for a specific injury). In a nutshell the IME’s judgment on an injured worker’s tattoos (or other “features”) has no relevance, and can be used against that IME!
Can an Independent Medical Examiners (IME) medical opinion about an injured worker’s work-related injury override the medical opinion of the injured worker’s own treating doctors and top specialists?
A case example:
I was injured on the job in (months) of this year. Approx. (month) I returned to work with restrictions. (3 months later) my employer terminated my suitable duties, which places me back on workover payments. An examination with an IME has been scheduled (in 6 weeks), but I do not return to my doctor until (7 weeks). Can the IME’s decision stop my weekly payments?
An other case example:
On (month), my employer conducted meeting, which is supposed to be an ongoing dialog with me the injured worker and my employer to find reasonable accommodations/adjustments for me to perform essential work duties. I am a bus driver and my injuries were to both shoulders. My doctor placed me on suitable/modified duties, until (month), restricting my driving. Once my suitable/modified/alternative duties were terminated, the workcover insurance carrier for my employer decided to send me to an IME. I have found that these Examiners are never ‘independent’. It seems that the employer is trying to force me back to work before my doctor has cleared me to do so.
If the IME doctor releases you to full duty then, unfortunately, the workcover insurance company can (and will) terminate your benefits such as weekly payments. If you don’t agree or if your own treating doctors and specialists still want you on restricted duty then you will need to request a dispute resolution (i.e. Conciliation/ Hearing before the workers comp commission to decide the issue.)
If you do not have a lawyer at this stage, this would also be a good time to hire one.
Workcover insurance companies use IMEs to try and force a favourable medical opinion they can use to cut off benefits in workers’ compensation cases.
Legally, an IME is just a separate medical opinion from someone who is not the injured worker’s treating doctor. By itself, IME reports are not considered authoritative. However, workcover insurance companies will almost always take the approach that if an IME says your do not have a physical impairment, or that your injury is not work related, or you are fit for work, then that somehow justifies them in terminating your medical benefits (i.e. even deny surgery) of weekly payments. Again you can appeal any decisions your insurance company (case manager) has made based on a (biased) IME report. Depending on the state you live in, this can be Conciliaton, arbitration etc.
The sad reality is that
The Case Managers (who have no medical training), employed by the workcover insurers, and the Return to Work Coordinators have the right to withhold treatment recommended by specialists, or to over-rule evidence based treatment based on thorough medical knowledge.
Advice from the most senior Medical Staff in the country can be over-ruled by Case Managers, and often Orthopaedic or Neurosurgery is delayed or never done on the whim of a Case Manager “who decides that it is not necessary.” Insurers regularly use Medical Advisers that are known to provide reports favourable to the Insurer. These appear to be used to prevent reasonable care to injured workers, especially if the injury is complex,or has been ongoing for a significant period….
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