L&I Independent Medical Examinations (IME)
An IME is a medical evaluation requested by the Washington State Department of Labor and Industries (L&I) or a self-insured employer to review your medical history and accident details, to establish finding, opinions, and conclusions about your physical condition. IMEs are conducted by approved L&I providers and IMEs are intended to be objective, so no patient-provider relationship is established.
When Can An Independent Medical Exam Be Ordered?
There are specific circumstances in which you might be ordered to attend an IME. The Washington State Legislature has outlined IME guidelines about the requirements for attendance.
An IME does not constitute medical treatment, rather the purpose of an IME is to help the insurance company determine the reality and extent of your injury by:
- Gathering information on your condition.
- Determining maximum medical improvement (MMI) 20.01002.
- Deciding if your condition is, in fact, directly related to your workplace injury or occupational illness and then denying or awarding L&I benefits.
- Ending your medical care.
- Closing your L&I claim.
Are Independent Medical Examinations Biased?
Unfortunately, IMEs can be problematic. For one, the injured worker does not usually get a say in who conducts their IME. What’s more, L&I doctors are rarely neutral or objective. 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 worker is fine.
How Are IME Doctors Selected?
In Washington State, an IME must be provided by an L&I-approved provider. These doctors are paid by L&I or the self-insured employer, and their main goal is to give you an unfavorable report. These providers are seen as experts, and their opinions are given significant weight—so the doctor chosen for your IME will greatly influence your case.
Scheduling An IME
L&I and self-insured employers (SIEs) usually determine the date and time of an IME evaluation. If you need to reschedule your IME, contact your L&I Claims Manager immediately. If you have a conflict with the scheduled date, obtain permission to reschedule the exam. The Claims Manager will most likely accommodate reasonable requests and arrange for the exam to be conducted on a different date.
Do’s And Don’ts For Your Independent Medical Exam
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. The process is riddled with IME doctor tricks designed to ruin your claim, but with the right preparation, you can minimize damage to your case by following these tips:
- Remember that you will be under observation at all times: from the moment you arrive until you leave the premises, all eyes are on you. The IME physician will be looking for any signs that cause suspicion or that contradict your L&I claim.
- Bring an observer: you may bring an observer to your IME appointment to take notes, but recording audio or video is not permitted. You may not bring an observer to a psychiatric IME appointment.
- Be polite and cooperative: follow directions and refrain from making negative comments about your employer or the exam itself.
- Be honest about relevant previous injuries: insurance companies are skillful at uncovering past injuries that could hurt your L&I claim.
- Provide a thorough medical history: it is important to share any and all symptoms, injuries, and medical care related to your case.
- If you experience pain at any point during the examination, let the doctor know: describe how the pain feels and where it hurts, using words like searing, stabbing, or throbbing.
- Do not sign any paperwork other than the sign-in sheet.
- Do not answer questions that pertain to fault or that are irrelevant to your case: this includes answering any questions about unrelated medical problems.
- Do not agree to invasive tests or procedures: you do not have to endure painful procedures or agree to tests that your primary care doctor has already done.
- Do not wear restrictive or inflammatory clothing: avoid wearing clothing that restricts movement or may convey a negative message about you.
Can I Receive Travel Reimbursement For Attending An IME?
Yes, travel reimbursement is authorized for attending an IME.
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.
After Your Independent Medical Examination
Once your exam is complete, the results are compiled in an IME report, which is sent to your self-insured 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. 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 can make a big difference in your case.
What Is In An Independent Medical Exam Report?
The purpose of an IME is to help the insurance company determine the reality and extent of your injury. The L&I provider’s findings are then used to deny or award benefits for your workers’ compensation claim to help you recover and pay for treatment.
The following are the conclusions that the IME doctor may include in their report:
- 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, meaning that it was not the result of a workplace accident or injury.
- Release to work: the worker can still perform light-duty work and is required to return to work.
- No additional treatment: the worker doesn’t need surgery or the procedures requested.
- Impairment rating: an impairment is a “loss, loss of use, or derangement of any body part, organ system, or organ function,” and can develop from a workplace injury or an occupational illness. An impairment is considered permanent when an injury has reached maximal medical improvement (MMI) and determines how much an injured worker will get paid based on their injury as determined by the American Medical Association’s Guides to the Evaluation of Permanent Impairment.
It is important that you have the right medical opinion and support to ensure that you receive the highest rating available. If you feel that you have received an inappropriate rating, you can ask L&I for increased impairment benefits.
Closing Your L&I Claim
Your L&I claim closes when a physician certifies that further treatment will not improve your condition, meaning that you have met maximum medical improvement (MMI), and you have returned to work or that L&I has determined that you are fit to return to work.
What Happens After Your L&I Claim Is Closed?
- If you do not protest or appeal within 60 days, the closing order becomes final.
- If you protest or appeal, the L&I must reconsider the decision and then either affirm or reverse.
How Much Is My L&I Settlement Or Award Worth?
In Washington State, the money awarded to a claimant is determined by numerous factors making it difficult to provide an accurate L&I settlement calculator. Factors that determine a settlement or awarad amount include the date the injury occurred, the severity of the injury, and the steps the injured worker takes to receive the compensation they need.
- Permanent Partial Disability awards: payment is typically based on the type and severity of the injury and whether an independent medical examination (IME) agrees or disagrees with the physician’s opinion. Washington State L&I updates injury payouts each year based on the cost of living adjustments (COLA); the date of your injury will influence your L&I award amount.
- The seriousness of your disability: Your injury is rated as a percentage in its category or given a value of 1–9. Typically, the higher the number, the more significant your injury is. Your PPD award is calculated from those numbers before your case is closed. The Permanent Partial Disability L&I settlement calculator is the L&I Disability Awards Charts.
- What you’ve done to help yourself: if you’re proactive regarding your workers’ compensation claim and work hard to ensure your claim has the correct information, you could earn more in your award payout.
Your L&I Claim Is Worth More If You Also Have An Employment Law Claim
A significant number of L&I workers’ compensation claims often involve additional legal claims such as employment law or third-party claims. Many people file their claims without seeking representation from an L&I attorney and thus never discover that in addition to their L&I claim, they may be missing out on the ability to file an employment law claim or a third-party claim. Pursuing additional legal action has the potential to significantly increase a claim’s overall compensation.
What Is An Employment Law Claim?
Many injured workers find that their employer has taken, or plans to take, adverse action against them because they filed an L&I claim or they are out of work. You can file a lawsuit against your employer for several reasons, including retaliation, wrongful termination, disability discrimination, or unpaid wages. An L&I attorney who is experienced in both L&I workers’ compensation law and employment law can help you with your L&I claim while simultaneously filing a federal or state law claim for the violation of workers’ rights by your employer.
What Is A Third-Party Claim?
A third-party claim is one in which someone other than your employer or co-worker is responsible for your injury. If you have been injured on the job due to someone else’s actions or negligence, you may be entitled to additional compensation through a third-party claim, which combines your L&I claim with a personal injury claim using the same facts.
Unlike workers’ compensation payments, there is no limit to the amount of compensation an injured worker may seek in third-party damages.
Who Is At Fault For A Workplace Injury?
L&I is a no-fault system, ensuring compensation for any workplace injury. However, if a third party is involved in causing the injury, you may be able to pursue legal action against them for additional compensation under third-party claims.
How Do I Know If I Have A Case?
The bottom line is that anyone who isn’t familiar with L&I claims should seek the input of experienced L&I attorneys who do.
Emery | Reddy Can Help You With Your L&I Claim
To learn more about IMEs, read our essential tips. Emery | Reddy, PLLC is the only law firm in Washington State that is equipped to provide comprehensive representation on your case from every angle. Our Seattle L&I attorneys thoroughly assess every case to determine if our clients have additional claims, and at times this can extend far beyond the underlying workers’ compensation claim.
If you have been injured in the workplace call Emery | Reddy today to speak with our legal team for a free case review. Please remember to have your L&I claim number readily available.
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