How L&I Uses Independent Medical Examinations (IME) to Fight Claims
L&I (and self-insured employers) have 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.
L&I orders IME’s for two reasons:
- L&I is getting ready to fight a Workers’ Compensation Claim; or
- It needs more information to decide whether or not to accept or deny a claim
When the IME process is used to gather information, it may not result in a claim denial. But when it’s used to fight a Workers’ Comp Claim, it’s designed to prepare and support a permanent claim denial.
Once an L&I (or self-insured) Case Manager orders an IME to fight your claim, you should immediately contact an L&I attorney. Workers’ Compensation attorneys will analyze your claim at no cost to you.
L&I (and self-insured employers) use IME’s to fight claims through a multi-step process:
- The Claims Manager (CM) reviews the claim and decides to fight it (CMs often fight claims they don’t believe, think are exaggerated, or think don’t require extensive medical care)
- The Claims Manager orders an IME
- The injured worker is forced to see an L&I Independent Medical Examiner – a doctor that works for L&I (or the self-insured employer)
- 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 procedures that he/she has requested
- Maximum medical improvement– The worker is at maximum medical improvement, meaning he/she is as healed as he/she 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. The Department has been using this playbook for decades and is very good at building a case against claimants that they don’t believe, or they simply don’t like.
The best method of defeating L&I is to act immediately after receiving an IME letter. Contact the experienced Workers’ Compensation attorneys at Emery Reddy for a free case analysis.