If the workers’ compensation insurer or the Texas Division of Workers’ Compensation requests an independent medical examination (IME), you must submit to the examination. Failing to attend and cooperate during an IME could be grounds for denying your workers’ compensation claim. Therefore, understanding your rights regarding an IME is the first step in protecting yourself against a biased and pro-insurance medical report.
What is an Independent Medical Examination in a Workers’ Compensation Case?
Many workers are surprised to learn that they cannot choose any physician for treatment after a work-related injury. In an emergency, you can seek medical treatment as necessary. However, in non-emergency situations, you must choose a doctor from a list of approved physicians to treat work-related injuries and illnesses.
In addition, the Divisions of Workers’ Compensation (DWC) or the insurance provider may request a doctor to conduct an independent medical examination. IMEs may be used in personal injury cases, but they are more common in workers’ compensation claims.
A designated doctor selected by the DWC performs the IME to resolve a dispute regarding your work-related injury or illness. You or your attorney may also request the DWC appoint a designated doctor to perform an IME.
The designated doctor reviews your medical records and other documents related to your injury, illness, and medical treatment. In addition, the designated doctor may conduct an independent physical examination to clarify any issues.
Questions that the designated doctor may address include, but are not limited to:
- Do you need additional testing or medical treatment for your condition?
- Was the medical treatment you received satisfactory to address your work injury or illness?
- Did a prior injury or illness contribute to the cause of your current condition?
- Did the treating physician correctly diagnose your medical condition, illness, or injury?
- Did a work-related condition or accident cause your injury or illness?
- Are you able to return to work with or without restrictions?
- Did you sustain permanent impairments or disabilities because of the work injury?
The insurance company often uses the IME to declare that you are fit to return to work. By doing so, the insurance company avoids paying continuing wage benefits and medical bills.
However, the results of an IME may not be unbiased and objective. For example, a designated doctor might be pro-employer, which could work against you. If you receive a demand for an independent medical examination, seek legal advice from a Houston workers’ compensation lawyer.
An attorney explains your rights regarding an IME. The lawyer understands the rules and procedures for the exam. They can also help you appeal the results if necessary.
Things You Should Know Before an Independent Medical Examination
If you are required to submit to an IME, things to be aware of include:
- There is no patient-doctor confidentiality during an independent medical examination. Anything you say to the doctor may be included in the doctor’s report to the DWC and the workers’ compensation insurance company.
- The doctor’s observations may be included in the report, including your physical abilities and mental clarity.
- The doctor may begin by asking you how the injury occurred. Answer the question honestly without embellishing the truth.
- Be prepared to provide details regarding your injury or condition, including specific symptoms. You need to be able to provide the beginning and duration of symptoms.
- It is wise to review your medical records from your treating physician before the IME with your workers’ compensation lawyer. Reviewing the medical records can help you answer the designated doctor’s questions.
- Avoid downplaying your injury. Your IME is not the time to prove your pain tolerance. Instead, be honest about your physical limitations and restrictions.
- Always tell the truth. If you lie or exaggerate your symptoms, the doctor will know; your credibility will be in question.
- Stick to straightforward facts. Do not use overly descriptive language so past and future statements match.
- Answer truthfully when the doctor asks you about your medical history and prior injuries or conditions. You should have disclosed this information to the treating physician. Hiding prior injuries or medical conditions could jeopardize your workers’ compensation claim.
Your workers’ compensation attorney helps you prepare for the IME. They may have additional tips and instructions regarding the examination.
An independent medical examination does not mean you will lose your workers’ compensation benefits. Scheduling an IME does not mean your claim will be denied. However, an IME should be taken seriously. Having sound legal advice is the best way to protect yourself.