Tag Archives: IME

“Independent” Medical Examinations in Workers’ Compensation (Anything but “Independent”)

Today’s post comes from guest author Thomas Domer, from The Domer Law Firm.

“I thought their doctor Independent Medical Report was the last word on my case. I didn’t know any better.” 

This statement from a client I just met sums up the experience of many injured workers unfamiliar with the workers’ compensation process in Wisconsin (and many other states).

An insurance company or self-insured employer may request an injured worker submit to reasonable examinations by a physician, chiropractor, psychologist, dentist, podiatrist, physicians assistant, or Advanced Practice Nurse Practitioner of its choice. Wis. Stat. §102.17(1)(b). This examination is usually referred to as an Independent Medical Examination or “IME” although “adverse medical examination” more accurately reflects the process.  An Independent Medical Examination may be requested by the insurance company or self-insured employer in order to determine whether the claim is compensable and the extent of the disability or the necessity and type of treatment. 

Since only about one in ten injured workers in Wisconsin is represented by an attorney, nine out of ten unrepresented workers are not aware that the insurance company’s “IME” is actually an adverse exam by a doctor hired by and paid by the insurance company to issue his report. Although IME examiners would deny they routinely render an opinion in favor of the insurance carrier, my forty years of experience suggests just that. For many years lawyers representing injured workers have been proposing the terminology “Adverse Medical Examination” apply to give represented and unrepresented workers a more fair assessment of the process. Many IMEs make hundreds of thousands of dollars annually performing these examinations. At one of these examinations, my client overheard the IME physician (who had rented a motel room) speaking to a prospective young doctor trying to convince that doctor to perform IMEs. “This is a great practice.” He said.  “All you have to do is review the medical records, meet with the worker for a few minutes, and deny the claim. And for that you can charge $1,500.” Although my client’s testimony to this effect was barred, the underlying accuracy of his testimony is undisputable.

Beware the “Independent” Medical Examination.

What’s Happening to North Carolina’s Workers’ Compensation Act? (Part III)

Today’s post comes from guest author Leonard Jernigan, from The Jernigan Law Firm.

In Part I and II of this series we discussed the legislative power shift in 2010 and identified four significant changes.  Here are some more legislative changes, all imposed after 2010: 

 

    5.   Even If The Claim is Denied the Employer Can Still Get An IME

Before 2010, although an employer might be able to get the employee’s medical records once the claim was filed, if the claim was denied the employee took the position that the employer had no right to force the employee to go to an insurance-selected physician for an IME.  That has now changed. 

    6.   In Second Opinion Rating Evaluations Certain Medical Evidence Can Be Ignored.

An employee has an absolute right to get a second opinion about the extent of a permanent injury, if dissatisfied with the impairment rating given by the insurance-selected treating physician.  Occasionally, this new physician, who was selected by the employee, would make a medical finding that the employee needed further medical treatment or would diagnose another medical condition that had not been evaluated by the treating physician.  This new information would be the basis of a motion to the Industrial Commission for additional medical care.  New legislation states that as to any opinions unrelated to the rating the Commission “must either disregard or give less weight” to these medical opinions.

    7.   Restrictions on the Ability to Change Physicians.

Before 2010, the employee had the right to petition the N.C. Industrial Commission to change physicians.  Occasionally there were personality conflicts between the employee and the insurance-selected physician, or the physician would be ignoring certain complaints, or not reporting the complaints in the medical records.  When these matters were brought to the attention of the Executive Secretary’s Office, the Commission had the discretion to authorize a change of physician.  New legislation now requires that the Plaintiff prove by a “preponderous of the evidence” that a change is necessary. 

     8.   Greater Difficulty for Getting Second Opinion for Employee.

Before 2010, the employee could select a physician for a second opinion examination and request the Industrial Commission to approve this physician.  Now the employee must first request approval “in writing” from the employer and attempt to jointly agree on a new physician.  If this effort fails, then the employee can seek approval from the Industrial Commission.  This new procedure is a roadblock to allowing the employee quicker access to a different medical provider.

 

Part IV of the series will discuss other changes, including administrative changes, to the Act.  Stay tuned.

 

 

 

Mileage Reimbursement Set at 56 Cents per Mile for 2014

Today’s post comes from guest author Brody Ockander, from Rehm, Bennett & Moore.

Getting reimbursed for mileage and travel expenses is often part of the medical process in a workers’ compensation claim. However, it’s essential to keep detailed receipts and have a plan for submitting those expenses in a timely manner.

The federal government has set the 2014 mileage reimbursement rate to 56 cents per mile. This rate was effective Jan. 1, 2014. This is a decrease from 56.5 cents per mile last year, but the price of gasoline is also slightly cheaper.

Generally speaking, the federal rate changes annually. However, when gas prices went soaring in 2008, a mid-year increase went into effect.

As a reminder from a blog post that firm partner Todd Bennett wrote in 2011, injured workers can be reimbursed for activities such as “travel to seek medical treatment, pick up medications, or while participating in a vocational rehabilitation plan.”

The best way to do this is to work with your attorney and legal assistant to keep track of all mileage. This can include appointments for Independent Medical Exams (IME), too. Then your attorney can help you get reimbursed. 

It is often essential to save receipts and keep a record for yourself of your doctor’s visits and other reimbursable trips, including physical therapy and trips to pick up medication. Providing that log to your attorney and saving receipts incurred from specific doctor visits and other reimbursable trips creates a “narrative” that makes it easier to justify those expenses.

Because money is always tight for injured workers, contact an experienced workers’ compensation attorney if you have questions about a specific situation.

What Every Employee Should Know: Preparing For The Defense Independent Medical Examination (IME)

Prepping for your IME is important. Follow these guidelines to get ready.

After your work injury your employer has a right to make you go to what is called an “Independent Medical Examination” or “IME.” The IME is, basically, an examination by a doctor chosen by your employer who will take your statement of what happened and perform a physical examination. How you conduct yourself during the IME can help or hurt your case. I strongly recommend that all injured workers follow the recommendations below in preparing for an IME.

Before going to the IME, spend an hour or two writing down the history of your injury, including:

  • your current complaints based on the injury,
  • what things cause your injury to be aggravated,
  • and what care and treatment you have been given for your injury.

You will have only a limited amount of time to describe these things to the IME doctor. Therefore, you should take your written statement to the IME and hand a copy of it to the doctor. It is important that you have a well-organized statement. Then make sure what you say to the IME doctor is in keeping with your written statement. Save the written statement and give a copy of it to your attorney. He or she will be able to use the statement if the things you say in it do not end up in the IME doctor’s record.

You will probably be asked to describe your pain. Since pain is subjective, it is often difficult to describe. You might find it easiest to describe activities that worsen your pain. You should have a list of everyday activities that increase your pain. Be as truthful, accurate, and complete as possible.

Even if your care before the IME is poor, I recommend against complaining bitterly about that care. Instead focus on just describing the facts. If true, tell the IME doctor how the care so far has not worked and yet the company doctor continues giving you that same useless care; or how the company doctor spends more time communicating with the company representative than with you. Recall and apply that old admonition from “Dragnet”—“just the facts, sir, just the facts.”

After the IME, your attorney will be interested in knowing exactly what went on in the examination. Thus, after the IME, take at least one-half hour to write down as much as you can remember of the following:

  • what the doctor said,
  • what you answered,
  • what the doctor did,
  • and what if anything was dictated into a recorder,
  • the time that you arrived at the office (be as accurate as possible),
  • the time that you were placed in the examining room,
  • when the doctor entered the room,
  • and when the doctor left the room.

It may be important to have an exact record of the time the doctor spent with you in the examination room.

You need to spend some time to prepare for the IME. By following the guidelines set forth above, you will provide a truthful, accurate, and complete statement of your condition. Hopefully, the IME doctor will then provide your and your employer’s attorneys with similar findings, diagnosis, and recommendations for treatment. Of course, you should spend some time talking to your attorney before any IME. Good luck!