According to Georgia’s personal injury law, if you’re a car accident victim or suffer a permanent impairment or other physical limitations due to a work-related accident, you have the right to file a workers’ compensation claim based on your medical examinations.
However, in their turn, the offender or the offender’s insurance company also has the right to ensure your entitlement of the workers’ compensation benefits by requiring an IME report from an independent medical examiner.
So, what does that medical evaluation involve, what’s the purpose behind it, and is it in favor of the injured party, the insurance carrier, or the insurance company? Keep reading while we discuss everything related to independent medical exams.
What Does IME Mean?
An Independent Medical Examination (IME) isn’t an appointment where you get additional medical treatment. Conversely, it’s a legal action that strives to get insurance companies and accident victims on the same page during settlement negotiations.
When you file a personal injury lawsuit against your employer or any other at-fault party, they have the right to request a defense medical exam, where they can consult or take a second opinion from a physician other than your treating doctor.
For all they know, your case might be aggravated due to previous injuries, which they shouldn’t be held accountable for. They also want to double-check whether you really need the surgery or the extensive medical care your private doctor prescribed and when you’ll be able to return to your daily activities to stop paying you lost wages.
Based on the report the doctor performing the IME will write, your physical condition and your need for further medical attention will be more evident to the judge who’ll decide whether your medical bills should be covered by the insurance company or not.
What’s the Purpose of an Independent Medical Exam?
In theory, the purpose of independent medical examinations is to resolve the medical dispute between both parties fairly. However, the fact is that these examinations aren’t as independent as they’re made to sound.
Doctors who conduct IMEs are almost always chosen and paid for by the insurer. That means while their role is to examine injured workers to verify their workers’ compensation claims, what they really do is try to find evidence that can excuse insurance companies from paying the claims.
Another factor that makes this process a bit unfair is that most IME doctors are semi-retired physicians left in active clinical practice for lawful purposes. Their main income comes from the IME reports they write for insurance companies, so it’s only natural they’d want to please insurance companies to be hired to do the job in other cases.
To combat this unfairness, you’ll want to take legal advice from an experienced workers’ compensation lawyer or law firm, as they’ll help you prepare for the physical exam and preserve your rights.
What Can I Expect in an IME?
During the IME visit, the insurance company’s doctor will examine your medical condition, symptoms, the treatments you took, as well as the tests you performed, including your MRI reports, X-rays, and CT scans. They’ll also check your medical history for any relevant medical information that testifies that your injury wasn’t caused by a work accident.
Also, there won’t be the doctor-patient relationship you’re used to in regular medical appointments. The visit will be short, not exceeding 30 minutes, and everything will be recorded, so you should be aware of anything you say in the examination room, as it could be held against you later, and you’ll find out in the report.
Finally, the IME physician will write the report based on their findings and judgments.
How Can the IME Affect My Case?
After the IME doctor submits the report, you and your lawyer receive a copy before the case is taken to court.
Although most IME physicians will be biased towards insurance companies, workers’ comp judges trust their words fully because, for them, they’re a more objective party than your private doctor. So there’s a chance your claim will be denied even if you deserve the compensation.
What if the Results Come In Favor of the Insurance Company?
In case your workers’ compensation case is denied, you can do one of the following:
- Investigate whether the examining doctor who took your case was really qualified.
- Ask to review the results of your physical examination with the insurance company for false information if you’re sure there was a mistake in your medical reports.
- Let your workers’ compensation attorney file a lawsuit for lying or fraud against the IME doctor if you both see there’s something that raises suspicions between the IME doctor and the insurance company.
What Happens if I Refuse to Attend the IME?
In general, you can’t say no to an IME appointment if it’s already set. Doing so won’t necessarily put you under arrest but will make you lose your workers’ comp case before it even begins.
By refusing to attend, you snatch yourself the right to submit any medical records that aid your claim, and in turn, you automatically lose the case. And the worst part is that you leave the door open for the insurance company to sue you for making a false accusation and ask for compensation for the fees and expenses they paid to make a defense case.
If you’re suspicious that your employer or the at-fault party is trying to deny your claim or cut your benefits by this IME, there are safer actions to take. For example, most of the time, you aren’t obliged to consent for the IME doctor they choose, so you and your attorney can ask for a more neutral state-hired doctor.
Also, know that you’re allowed to have company during the IME, whether it’s your attorney or a family member. Having someone else with you during the visit can take the visit’s weight off your shoulders and help you answer the doctor’s questions with more confidence.
To wrap up, while an IME is designed to provide an unbiased opinion in a workers’ comp case, many IME doctors treat it as a means to save the insurance company money.
To be able to get your benefits, be honest about your injury as any lies can be detected and held against you later. Also, hiring an experienced attorney will make the entire examination process much easier to deal with.