What if an Independent Medical Examination Doctor Says My Workers’ Comp Claim is Invalid?

In Washington State, workers have the right to choose their own doctor (often the patient’s family doctor) to administer care for a work injury.  Within the Department of Labor and Industries, and the workers’ compensation system, that provider becomes your “treating doctor.” Yet there are cases where an employer or insurance provider may choose an alternative doctor to complete an IME exam, or “independent medical evaluation.” According to the workers’ rights advocacy group known as the National Association of Injured & Disabled Workers (NAIDW), IMEs are serves the following three purposes:

  1. to determine the cause, extent and medical treatment of a work-related or other injury where liability is at issue
  2. to determine whether an individual has reached maximum benefit from treatment
  3. to determine whether any permanent impairment remains after treatment

A Workers’ Compensation Attorney Can Help

Once you receive notification that you have been schedules for an IME, it likely means that your employer (or private insurance company) intends to dispute some portion of your workers’ compensation benefits. Independent medical examiners often base their prognosis on very brief examinations of a patient. Sometimes they don’t even conduct a medical exam before documenting their opinion.  Only in rare cases are their medical opinions in favor of an injured worker.  For this reason, workers should contact an L&I attorney when they are notified that an IME has been scheduled for them.  While an IME doctor is allowed to recommend medical treatment, they should not actually render that treatment since they are not the patients’ treating doctor – in other words, they do not have an official “doctor-patient relationship.” Workers who agree to let these physicians administer medical treatment, may end up unwittingly transferring their medical care to the insurance company’s hired gun.

When an IME is scheduled, a workers’ compensation attorney can serve to protect your rights.  If you aren’t represented by an attorney when the exam is scheduled, you should at least consult with one in advance of the medical examination. This is crucial in order to ensure that the IME doctor has received the necessary medical records and reports before they devise an opinion. Furthermore, an attorney may be necessary to help you determine if that physician is qualified in the medical specialty related to your injury.  It’s also critical to compare the verdict from the IME doctor with the findings of your usual personal physician.  Ultimately it’s up to Washington’s Department of Labor and Industries board of appeals (or a court in your particular district) to determine which doctor’s opinion is more credible.

L&I Injury Benefits

Often your work injury attorney will discover that the IME doctor runs a practice largely based on these superficial exams, which makes them biased toward medical “findings” that insurance companies are looking for; unfortunately, this means that an injured worker’s history and conditions are mischaracterized, jeopardizing their L&I benefits.

Workers are strongly advised against going into the IME without first consulting an attorney.  An experience workers compensation lawyer can prepare you for the questions you will face, and coach you through a situation where everything you say may be used against you if the doctor sees the opportunity.  However, even if you disagree with the IME doctor, you should avoid any direct confrontations with them. Your lawyer can do this properly and effectively, ensuring that you receive the workers compensation benefits you deserve for your workplace injury.

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Emery Reddy