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, make no mistake – your L&I claim is on the line. 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 and how to prepare yourself.
What is an Independent Medical Examination?
An 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 from the IME.
Are Independent Medical Exams required?
Insurance companies and employers are legally allowed to require you to attend an independent medical exam.
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 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.
What Do I Need To Know Before An Independent Medical Evaluation?
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:
- Have someone accompany you to the examination—preferably your significant other or a trusted friend, a professional appointed by your attorney, or a nurse. The accompanying person should take detailed notes or make an audio recording of the exam.
- 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 to 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.
When You Should Contact An Attorney
Once an L&I claims manager orders an IME 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.
If you would like confidential advice and professional consultation before your IME, we can provide you with essential tips. The L&I attorneys at Emery Reddy have successfully prepared hundreds of clients for their IMEs and have over 15 years experience handling L&I claims, employment law cases, and third party injury claims. Call us for a free case analysis and see how we can help you get the workers’ compensation benefits you deserve.
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