The Independent Medical Examination Report is in…Now what?
You attended an independent medical examination, or IME, at the request of your employer, and the report is in. What do the doctor’s conclusions in the IME report mean for your workers’ compensation case? Below are a few quick answers to common questions employees have regarding how an IME report can impact their workers’ compensation case.
The IME report is in and the doctor disagrees with my treating physician. Is my case over?
No. It is not uncommon that an IME doctor disagrees with your treating physician on whatever issue or issues were in question. This may be because the IME doctor reviewed different records, follows different treatment plans, or just disagrees with your treating physician. Where there are differing opinions between your treating physician and the IME doctor, then you case boils down to determining which doctor’s opinions are most credible.
The IME doctor disagreed with my doctor and my employer stopped paying benefits…can they do that?
Unfortunately, yes. Once your employer has an opinion contradicting your treating physician’s opinion, your employer can refuse to pay additional benefits, authorize additional treatment, accommodate your work restrictions, etc. The arbitrator will then decide which doctor is more credible, typically after both your doctor and the IME doctor have been deposed to allow your attorney to further explore the bases for each of the doctors’ opinions.
How does the arbitrator determine which doctor is more credible?
Historically, the opinions of treating physicians were found to be more credible, since a treating physician has worked with you throughout your recovery and has a more in-depth understanding of your injury and treatment than a doctor who saw you once for the purposes of drafting a report in anticipation of litigation. However, this balance has shifted somewhat as the environment surrounding workers’ compensation claims has grown more conservative. The arbitrator will look at the records available for review by each doctor, how the history of accident presented is corroborated by the medical records, the studies on which the doctor bases his conclusions, and a number of other potential factors, depending on the circumstances of your case.
Since the IME doctor is paid by the insurance company, the doctor always says whatever the insurance company wants, right?
No, although that does tend to happen more often than not. The fact of the matter is that some IME doctors almost routinely draw conclusions favorable to the insurance companies, while other doctors provide unbiased reports based solely on the facts presented.
The IME report agreed with my treating physician. Everything will be approved, right?
Almost always. If the IME physician agrees with your treating physician regarding causation, proposed treatment, etc., your employer will generally act in accord with the IME doctor’s report. Occasionally, an employer will refuse to abide by their own doctor’s recommendations. However, if the IME doctor agrees with your doctor, regardless of the employer’s position, the arbitrator will almost without question order the employer to do as the IME report says.
When an IME doctor does not agree with an employee’s treating physician, employers will use this as justification for stopping the employee’s workers’ compensation benefits. It is important to have an experienced workers’ compensation attorney on your side who will work to ensure the arbitrator determines your doctor’s opinion is the most credible. Call the attorneys at Woodruff Johnson & Evans Law Offices at (630) 585-2320 to discuss how we can help you get the benefits you deserve in spite of a negative independent medical examination report.
Written By: Lynn Taylor, Workers’ Compensation Attorney