IME Exam For L&I Claims In Washington
During the course of your workers’ comp claim, you may be required to complete an Independent Medical Exam (IME) conducted by a doctor other than your primary provider. The purpose of this exam is for L&I to get an expert opinion regarding your medical condition. However, independent medical examiners sometimes misdiagnose a patient or mischaracterize a workplace injury as a preexisting condition.
If you’ve been asked to attend an IME exam, make no mistake—your L&I claim is on the line. Washington IME doctors work for L&I and their opinions are designed to support L&I decisions. Read on below to learn more about the IME process, tips, and how to prepare yourself.
What Is An Independent Medical Examination?
An Independent Medical Exam (IME) is a patient interview requested by L&I to review your medical history and details of your accident, followed by a physical examination of the injured area. An IME takes about 30 minutes, but it can be several weeks or months before you hear back from L&I regarding the outcome of the IME report.
Reasons For A Washington IME
When it comes to IME and workers’ compensation, your primary care physician is not considered a neutral party for evaluating whether or not you deserve compensation, as they would likely be biased in your favor due to your pre-established relationship.
Thus, L&I requires that you seek an Independent Medical Examination from an objective L&I doctor who can validate your injury and provide a neutral second opinion on your condition. To be clear, an IME evaluation does not constitute medical treatment. The purpose of an IME is to help the insurance company determine the reality and extent of your injury. The L&I doctor’s findings are then used to deny or award workers’ comp benefits to help you recover and pay for treatment.
Whenever there is a discrepancy in treatment, a determination if a new condition is as severe as reported or cannot be attributed to a preexisting condition, or if the claim is coming to a close and needs a PPD rating, an IME is scheduled. Their findings are written up for workers’ compensation purposes in an Independent Medical Examiner report (IME report).
What Is In A Workers’ Comp IME Report?
The workers’ comp IME report is like a medical record that is used to manage your injury claim. The doctor will thoroughly review your medical records and write out the findings of the report, sometimes before you’ve even undergone the evaluation. In the IME, the doctor usually only spends a few minutes with you to reinforce their pre-prepared conclusions. These conclusions will say something like:
- The medical condition was preexisting.
- The injured worker may return to the job without restrictions.
- There is no permanent partial disability related to the work injury.
- The worker’s medical condition has reached maximum improvement.
Are Independent Medical Exams Required?
Independent Medical Examinations are usually requested by the insurance company, the employer, the legal counsel, Labor & Industries, a court, or your doctor. Insurance companies and employers are legally allowed to require you to attend an Independent Medical Exam. They want to find out whether your injuries are the direct result of a compensable event.
If a claims manager reviews the claim and decides to fight it, they will order an IME. You are then required to see an IME who works for L&I (or the self-insured employer if the employer has opted out of L&I).
The doctor’s report could come back with one or more of the following diagnoses:
- Faking or exaggerating: the claimant either isn’t injured or isn’t injured badly enough to warrant the level of care and time off requested.
- Injured outside of work: the worker was not injured while on the job.
- Preexisting condition: the worker’s injury was preexisting; not the result of a workplace accident or injury.
- Light duty: the worker can still perform light-duty work and is required to return to work.
- No surgery: the worker doesn’t need surgery or the procedures requested.
- Maximum medical improvement: the worker is at maximum medical improvement, meaning they are as healed as they ever will be, and must return to work immediately.
L&I cites the IME to shut down the claim. It’s a devastatingly effective process that serves to destroy many Washington workers’ compensation claims. L&I has been using this playbook for decades and is very good at building a case against claimants whom they don’t believe, or they simply don’t like. If you received a letter that you’ve been scheduled for an IME, we strongly recommend consulting an attorney prior to attending the appointment.
When Can IMEs Be Ordered?
As the injured party, you may not want to attend an Independent Medical Examination and risk your chances of compensation. Unfortunately, there are specific circumstances in which you might be ordered to.
Some states have laws that allow insurance companies to require IMEs when the claimant’s injury is deemed questionable. However, the insurance can only force the IME if the policy language is specific about requiring the insured individual to submit an IME report. The Washington State Legislature has outlined independent medical exam guidelines about the requirements for attendance.
What Happens When An IME Is Ordered?
Once an IME evaluation has been ordered, it is in your best interests to obtain the IME as soon as possible so the doctor can evaluate the full extent of your injuries. If you wait too long, your body will start to heal, and your IME may not reflect the true severity of the injuries you initially sustained from the accident.
When you attend the exam, you are permitted to bring a companion such as a friend or family member. You may not record your IME. Also, no companion is allowed into a psych IME. In rare cases, you might have to undergo more than one IME, but the party ordering the IME typically has to pay for it.
Scheduling An IME
L&I and self-insured employers usually determine the date and time of an IME evaluation. If you have a conflict with the scheduled date, you must contact the claim manager and obtain permission to reschedule the exam. The claims adjuster will most likely accommodate reasonable requests and arrange for the exam to be done on a different date.
What If I Can’t Travel?
Anyone who is unable to travel due to a physical or mental injury will likely need to request alternative transportation arrangements in order to attend the exam. Insurance companies are obligated to make transportation available to and from their appointment at no cost. They will send a driver to your house to take you to the exam and drive you home when you’re done.
What Do I Need To Know Before An Independent Medical Examination?
The decision handed down by the IME doctor can make or break your L&I claim, so it’s crucial to ready yourself ahead of time. With the right preparation, you can beat the IME and minimize damage to your case by following these tips:
- Be aware that you will be under observation at all times, from the moment you get out of your car in the parking lot until you leave the premises. The IME physician will be looking for any signs that cause suspicion or that contradict your claim of an injury. Some independent medical examiners set up scenarios that catch patients off-guard; for instance, a doctor may drop something or make a sudden movement that triggers the patient to quickly turn his or her head.
- Do not sign any paperwork other than the sign-in sheet.
- Be polite and cooperative with the IME doctor, but do not answer questions that pertain to fault or that are irrelevant to your case (such as questions about unrelated medical problems). Don’t talk negatively about your employer, either.
- Be honest about relevant previous injuries. Insurance companies are skillful at uncovering past injuries.
- Provide a thorough history of the symptoms, injuries, and medical care related to your case.
- If you experience pain at any point during the examination, let the doctor know. The IME exam is no time to be tough or conceal your pain.
- Do not agree to invasive tests or submit to procedures that your regular doctor has already performed. In addition, you do not have to endure painful procedures.
Are Independent Medical Examinations Biased?
Unfortunately, IMEs are typically problematic because of the bias inherent in the process. For one, the injured party does not usually get a say in who conducts their IME. What’s more, L&I doctors are rarely neutral or independent. They tend to be more loyal to the insurance company that hired them, and in many cases, their reports and assessments will try to make the case that an injured person is fine.
It is not uncommon for judges to reject workers’ comp IME reports from doctors because they are biased and error-ridden, but even so, these reports are still used in IME workers’ compensation cases. As such, you should consult your attorney before undergoing a Washington IME.
How Are IME Doctors Selected?
The way an IME doctor is chosen depends on the state you live in. Some states allow insurance companies to choose the doctor, while others will select a doctor from a list at random. In Washington state, an IME must be provided by a doctor on a pre-approved list from L&I. These people are seen as the experts, and their opinions are given significant weight—so the doctor chosen for your IME will greatly influence your case.
What Not To Do During An IME Evaluation
When attending your IME, you must conduct yourself very carefully. The doctor will look for reasons to believe you are faking your injury, and certain actions may heighten suspicions. Here are some things you should not do during the appointment:
- Don’t provide information about the injury unless asked for it.
The doctor will be looking for holes and inconsistencies in your story, so try to avoid talking about it unless asked direct questions, so you don’t sabotage yourself inadvertently.
- Don’t be too vague about your pain.
When the doctor conducts various tests to evaluate your pain level, avoid saying, “It hurts.” Describe how the pain feels and where it hurts, using words like searing, stabbing, or throbbing. Does your foot hurt, or does it feel like a hot needle is being jabbed through the center of your foot?
- Don’t be rude.
The IME doctor is the last person whose bad side you want to get on. Don’t get offended when they get personal—they are just doing their job.
- Don’t expect every test to be painful.
Because the doctor wants to rule out a faked injury, they will conduct a range of motion tests that do not inflict pain. Let the doctor know truthfully when something does not hurt.
- Don’t wear restrictive or inflammatory clothing.
Just as you shouldn’t wear clothing that restricts movement, you should also avoid clothing that sends a negative message about you.
After Your Independent Medical Examination
Once your exam is complete, the results are compiled in an IME report, which goes to your employer or L&I. Your doctor will also receive a copy and be asked to agree or disagree with the report. If they agree, they simply sign their initials—but if they disagree, they must write up a detailed report explaining why. You can see why this process is problematic; the doctor can quickly sign off on the results or spend an hour of their precious time trying to correct another doctor.
If L&I determines the claim can be closed, you have 60 days to appeal or protest. Work with your attorney to work through the appeals process in the most strategic way.
What Happens When An IME Doctor Disagrees With My Doctor?
If your primary care provider disagrees with your IME, count yourself lucky. It means you might get them to write up a report explaining the disparities in the IME conclusions. Your doctor’s input could potentially make a big difference in your case.
Issues That Can Impact Your L&I Claim
- Choosing the wrong doctor: as you can see, a good attending provider can sometimes make or break your case. Make sure you choose your own L&I-approved provider rather than seeing one that your employer recommends—and find someone who has a reputation for being caring and attentive. A dismissive or incompetent doctor will not only reduce your chances of compensation but may also keep you from getting proper treatment for your injury.
- Doing nothing to help yourself: when it comes to L&I, many people are working against you to rush your claim to a close. They want to do everything they can to minimize the amount paid out in workers’ comp, so you need to do everything you can to look out for yourself and be prepared. Research the process, prepare accordingly, and obtain a lawyer.
When You Should Contact An Attorney
Once an L&I claims manager orders an Independent Medical Examination to fight your claim, you should immediately contact an L&I attorney. They can identify any tests or procedures that aren’t appropriate to the IME counsel, and counsel you on risky or unfavorable subjects you should avoid discussing during the exam.
To learn more about IMEs, read our essential tips. The L&I attorneys at Emery | Reddy, PLLC have over 15 years of experience handling L&I claims, employment law cases, and third-party injury claims. Call us for a free case review and see how we can help you get the workers’ compensation benefits you deserve. Please remember to have your L&I claim number readily available.
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