How L&I Uses IMEs to Fight Workers' Compensation Claim
L&I Orders An Independent Medical Examination (IME) For Two Reasons:
- It needs more information to decide whether or not to accept or deny a claim
- It is getting ready to fight a workers’ compensation claim; or
An Independent Medical Examination is used to gather information, and it may not result in claim denial. But when it’s used to fight a workers’ comp claim, it’s designed to prepare and support a permanent claim denial.
L&I has close relationships with Independent Medical Examiners throughout Washington state. These doctors work for L&I and their opinions are often designed to support L&I decisions.
If you receive a letter that looks like the sample below, it means that L&I has decided to send you in for an Independent Medical Examination (IME).
Why Do Employers Fight Workers’ Comp Claims?
Workers’ compensation was created to protect injured workers, but there are some employers who oppose it for various reasons. As a result, many claims managers often fight claims they think are exaggerated or don’t require extensive medical care, or believe they are fake.
How Do Employers Fight Workers’ Comp Claims?
When a claims manager reviews the claim and decides to fight it, they will order an IME. The injured worker is then required to see an L&I independent medical examiner who works for L&I (or the self-insured employer if the employer has opted out of L&I).
The Independent Medical Examiner provides a report 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 and the Independent Medical Examiner’s opinion 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.
How To Prepare For An Independent Medical Examination
While an IME doesn’t mean an automatic denial of your case, the following suggestions can help you minimize the potential damage of an IME to your L&I claim:
- Have someone accompany you to the examination—preferably your significant other, a trusted friend, a professional appointed by your attorney, or a nurse. The accompanying person should take detailed notes.
- Be aware that you may 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.
- 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).
- 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.
While it is unlikely that the Independent Medical Examination report will be fair, with the right preparation, you can minimize damage to your workers’ compensation claim.
When You Should Contact an Attorney
The best method of defeating L&I is to act immediately after receiving an IME letter. Once an L&I or self-insured claims manager orders an IME to fight your claim, you should immediately contact an L&I attorney. A workers’ compensation attorney 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.
Call Emery | Reddy, PLLC today for a free case review. Please remember to have your L&I claim number readily available.