medical evaluation

It’s not uncommon for the insurance company to ask for an IME, and generally speaking, they are not necessarily a cause for alarm.

When you suffer a work injury or have contracted an illness because of your job, and open the worker’s comp process, you will generally receive treatment by a doctor of your employer’s choosing, as is stated in Missouri’s legislation.

In most cases, this decision is left to the insurance company, since they are the ones who will need to interact with the doctor throughout your claim, but you may also be asked to take part in an independent medical examination(IME).

So why, if the company chooses your doctor, would they ask for another examination from a third party? And what will this examination look like?

Why an Independent Medical Examination May Be Required

Usually, the insurance company will ask for an IME for two reasons:

• To clarify certain aspects of your injury or illness, before you even begin your treatment
• When they do not agree with the course of treatment

Say you went to your doctor with a cough. Upon investigating, your doctor tells you that you have some lung scarring you most likely got as a result of your job, where you are breathing in airborne dust. You file a worker’s compensation claim, as is your right, but the insurance company may not agree with the diagnosis, or that your condition is work-related. So, they ask for an IME to shed some light on the matter.

Or, say you’re already receiving treatment, from the doctor of the insurance company’s choosing. At one point, the doctor may recommend a certain expensive procedure, and the insurance company doesn’t want to pay for it. They will need an IME so establish if that procedure is really necessary, or if there is an alternative.

It’s not uncommon for the insurance company to ask for an IME, and generally speaking, they are not a cause for alarm.

What to Expect from an IME

Here’s what usually happens during an IME:

• The doctor reviews your medical records, and other records relevant to your injuries (sometimes, doctors may review them after the examination)
• You will meet with the doctor in-person for a discussion and an examination
• The doctor will ask you questions about your injuries, the accident, life after the accident, and make note of your answers
• Some physical exams and tests may also be performed

After that, the doctor writes a report and sends it to the insurance company. Note that this report holds a lot of weight, and if the IME report finds any inconsistencies in your case, or sides with the insurance company, your entire case may take a turn.

Ensure Your Rights Are Protected

If you haven’t yet done so, get in touch with an experienced St. Louis worker’s compensation lawyer as soon as possible. They can ensure you receive a copy of the IME report and help fight back against any claims that may jeopardize your claim.

Your doctor may recommend a Functional Capacity Evaluation. If so, you are probably wondering what this means, and how it could impact your claim.

FCE (Functional Capacity Evaluation) is a type of evaluation done to see if an injured worker has recovered enough from their injuries to go back to work. They are like physical therapy sessions where you are asked to perform a series of tasks, and one session can take up to three or even four hours. The tasks can vary, but you may be asked to lift weights, stretch, walk, bend, and other exercises to see how your physical condition is.

An FCE is generally nothing to worry about. However, you should know some things going in.

Why Are They Needed?

At some point, your doctor will need to decide if you are able to go back to work. However, though they know a lot about your medical condition, they are not trained to assess your physical abilities to perform certain tasks, which is why the FCE is done by another professional.

The person who performs the evaluation will record your performance and send it back to your workers’ comp doctor for analysis. In many cases, doctors will decide whether you are capable of resuming normal or modified work activities based on the evaluation.

However, the FCE is not a simulation of a normal day in your workplace. It has a set of physical exercises that, in some cases, have nothing to do with your work. As a result, it is possible to score well on the FCE, but not be able to resume your work.

Can I Lose My Benefits?

If the FCE determines you are capable physically to perform a variety of tasks, and your doctor clears you for work, then yes, you will no longer receive workers comp benefits. The problem is, if you go back to work, and are unable to perform your regular activities because your condition hasn’t improved yet, you’ll most likely need to be given another position that can accommodate you.

However, if you’re employer does not have such a position available, unfortunately, it is possible to lose your job. This is why it’s so important to educate your doctor on the particularities of your job. When they receive the FCE, tell them if the activities you were asked to perform don’t resemble in any way the physical strain your job normally poses.

What Can You Do?

You have the legal right to refuse to perform any task the FCE therapists asks you to. To protect your rights even more, you can take a friend with you and have them record the session.

It is also a good idea to speak with a St. Louis workers compensation attorney, who may accompany you to the meeting, and intervene if needed. Additionally, a lawyer can help you fight to keep your benefits until you’re fully recovered.

At some point in the workers’ compensation process, your employer may ask you to take a functional capacity evaluation (FCE).

A function capacity evaluation will assess your physical capabilities post-injury. If you are well enough, you may be able to come back to work. Even if you are not, the result can help you and your St. Louis work injury lawyer fight for your workers comp benefits. Here is what you need to know about these tests.

What Are They?

A functional capacity evaluation is a test given to injured workers to understand the extent of their injuries. If you receive one, your ability to do things like walk, lift objects, and complete other physical activities will be tested.

Why You Might Receive One

There are many reasons why you might get an FCE. The following are a few of the most prevalent.

Disability Eligibility – One benefit you might receive is for disability, which is given to those that cannot complete regular work activities. An FCE can prove your physical condition.

Medical Needs – FCEs can tell you and your lawyer if you will incur extensive medical costs when caring for your injuries.

Returning to Work – At some point, your damages may subside and you will be eligible to come back to your job. FCEs can tell your employer if that is possible.

Who Will Give It to You

Two professionals might administer an FCE. The first is your company doctor, provided that they have a certification to do so. If they do not, the company doctor will outsource the task to another medical professional that does have a certification. Often, this person’s official position is as an FCE Technician.

What to Expect from an FCE

At first, the technician will likely ask you a series of questions about your job, injury, and health history. Once they have an idea of who you are and what your damages are, they may  explain how to describe your pain. That usually means using a specific type of language to tell them where you’re hurting and how badly. Lastly, they will likely have you complete regular job functions such as standing, walking, pushing, reaching grasping, balancing, bending, and more. As you complete these tasks, they will take notes on how you look and when you feel pain.

How They Affect Workers’ Compensation Cases

If you receive an FCE soon after your injury, the results can inform you and your lawyer on how much compensation you deserve. If your abilities are compromised, they will likely entitle you to more benefits. Additionally, those results can tell you about how much money you’ll need to spend on physical therapy going forward. Lastly, an FCE can tell your employer whether or not you can come back to work. If you do well in the test, you may return to your old position or start working in a light-duty capacity. In these situations, your compensation would typically stop.

Now that you understand FCEs, you have a general idea of what to expect if you receive one. No matter what the results are, they are generally a positive thing for you. If you perform well, that means your health is improving. If you do not, you may be able to raise the sum of the benefits you are entitled to.

Speak with an Experienced Workers Compensation Lawyer

Call 24/7 :: (314) 361-4300

In Missouri, if you hurt yourself while you are work and performing under the scope and authority of your employment duties, then you are generally entitled to workers’ compensation benefits. Workers’ compensation is insurance coverage that is meant to cover an employee in the event that they are hurt while working.

There are very specific things that you have to prove to collect workers’ compensation benefits. The first is that you were engaging in work-related activities.

The Next Step

If you can prove that you were engaged in a work-related activity when injured, you must then show that you were in fact injured and to what extent. To do so, you have to seek medical attention to document what happened and to verify that you not only were hurt, but also how severely you were hurt, what your prognosis is, and what type of treatment you will likely need to recover from your injuries. 

The extent of your injuries will determine what benefits you are entitled to. For workers’ compensation, you are eligible to receive economic damages for medical costs and lost wages. If the injury is severe enough, you are also eligible to collect temporary disability or – in extreme cases – permanent disability payments. If you collect temporary disability benefits, you will get a portion of your salary while you are unable to work. The aim is for you to heal and return to work as quickly as you are able to do so.

What is an IME?

An Independent Medical Examination is when the workers’ compensation insurance carrier demands that you be evaluated by another medical professional. If the insurance company either believes that your injuries aren’t real, that they aren’t as severe as you claim, or even that they weren’t related to work activities, then they might require you to see another physician. It is their obligation to pay for the evaluation. However, you generally do have to comply, or they can deny your benefits going forward.

So What If the IME and My Physician Disagree?

If your physician and the IME come to a different conclusion, then the insurance company might try to deny you coverage, cut your benefits and demand that you return to work. However, you do have the right to appeal the IME’s diagnosis. In some cases the IME can be overridden, and your benefits will not be discontinued.