What Is an IME in a Workers’ Compensation Case?

Work-related injuries or illnesses can put you under both physical and financial strain. Without the ability to work, the bills pile up as your income disappears. Workers’ compensation can bring significant relief to your financial situation and provide you with coverage for the medical care you need to recover. 

To get benefits, you must first “pass” an independent medical examination conducted by an independent medical examiner. In other words, the exam is done by a doctor who is not already part of your medical team. Independent medical examinations can have a major impact on your claim’s approval. A workers’ compensation lawyer from John Foy & Associates will work with you to prepare for the exam and its outcome.

What Is an IME?

An IME is not a typical doctor’s appointment. While you will experience a full medical examination, the IME is actually more of a legal action whose goal is to reach a consensus among insurance companies, employers, and injured or ill employees seeking workers’ compensation benefits.

The insurance company supplying the benefits will request the IME to verify that your condition is a work-related injury, not an aggravation of an injury they should not be required to cover. They also want to confirm that any treatments, surgeries, or rehabilitation ordered by your team of doctors are necessary before they cover those expenses.

The acronym IME stands for Independent Medical Examination but may also reference the Independent Medical Examiner who carries out the evaluation. In other states, the acronyms AME, for Agreed Medical Examiner, and QME, for Qualified Medical Examiner, carry the same meaning.  

How an IME Matters to a Workers’ Compensation Claim

An IME can have a significant bearing on the outcome of your claim. If the examiner confirms your diagnosis and orders treatment, approval is likely. However, a dispute can prevent you from getting the care and coverage you need. 

Problems with IMEs

In theory, IMEs are a good way to ensure fairness since the examiner is an independent third party with no stake in the results. The injured party cannot make false claims to get “days off” with pay, and the insurer cannot refuse a legitimate claim. In reality, the playing field is not quite so level and is often biased in favor of the insurance company.

The doctors performing IMEs are paid by the insurance company. While the doctor’s job is to examine the injured party fairly and make an honest determination about their workers’ compensation claim, that does not always happen. Some doctors work in the interest of the insurance companies who pay them and look for evidence to exempt insurers from paying the compensation. 

Further, many doctors conducting IMEs are semi-retired whose main income is generated by the IME reports they provide to insurance companies. To be hired again, the doctor might feel pressured to give the insurance company the results it wants rather than the results the injured party needs.

A Workers’ Compensation Attorney Can Help

To ensure fair treatment through the IME process, connect with a workers’ compensation lawyer from John Foy & Associates. Your attorney knows the laws governing workers’ compensation benefits and insurance companies and knows how to help you prepare for your IME. You may have someone attend the IME with you, and if you want a legal representative present, your lawyer will accompany you.

If the IME report does not come back in your favor, your lawyer will continue to fight on your behalf and appeal the decision. Your attorney will:

• Examine the doctor’s qualifications
• Review the result of your physical exam to check for errors or outright false information
• File against the IME physician if there are red flags indicating an improper relationship between the doctor and the insurance company

What Happens During an IME?

At your examination, the insurance company’s doctor will evaluate your condition, considering your symptoms, treatments, test results, scans, or other information. The doctor will also review your medical history to see if any prior medical events represent the cause of your injury or illness.

Typically, visits last about 30 minutes. The examination is recorded, so it is important to know that anything you say in the exam room can be used against you later. 

Preparing for an IME

With so much on the line, it is easy to see how your nerves could get the better of you as you head for your IME. Nervous chatter or anxiety that prevents you from articulating what happened or how you feel will not help your situation. Fortunately, an experienced workers’ compensation attorney from John Foy & Associates will help you prepare for your IME so you can enter the exam room calmly and confidently.

For best results:

• Organize your thoughts: You will probably be questioned repeatedly about your injuries or illness and how they occurred. Your lawyer will help you prepare your answers so you can respond clearly, concisely, and consistently.
• Know your medical history: Review all medications you take and what you take them for, and be ready to answer questions about prior injuries or illnesses and treatments.
• Arrive on time: In fact, plan to arrive early. You do not want to increase your anxiety by having to rush. Arriving early also gives you time to think through and complete the required paperwork.
• Recognize the purpose: This exam is not like one you would experience with your own doctors. You will not have the same type of doctor-patient relationship.
• Be honest and cooperative: Answer the questions asked even if they become repetitive, and answer them truthfully and respectfully.

What Is Workers’ Compensation?

Under Georgia law, if you are injured on the job or become ill from your work environment, you may file a claim for compensation benefits. These benefits provide you with weekly checks for two-thirds of your usual wages tax-free and cover your medical costs, including transportation expenses for getting to your doctors’ appointments.

All business owners employing three or more workers must purchase workers’ compensation insurance, and coverage begins on an employee’s first day at work. While it is your right to file, your employer or the insurance company providing the workers’ compensation benefits has the right to seek confirmation of your condition, treatment, and benefits receipt. One of the ways they do is this by requiring you to undergo an Independent Medical Examination (IME) conducted by an independent medical examiner. 

We Fight for Workers’ Rights

Put yourself in the best position to get a favorable IME report and the benefits you deserve by joining forces with a workers’ compensation lawyer from John Foy & Associates. Your lawyer will guide you through the filing process, help you prepare for your IME, and fight until you get the compensation you deserve.