They may request an IME to prove that you were not injured at all.
Workers’ compensation is a type of insurance that employers are mandated to carry in Missouri. It’s an insurance policy that ensures that if an employee is injured while working, the employer has the assets to pay for their injuries. The trade-off is that if you are injured while working, you cannot collect for non-economic damages or sue your employer in a personal injury suit.
There are times when a workers’ compensation insurance company will allow you to go to your doctor, and others when they will send you to their preferred physician for medical attention.
In some cases, an insurance company will question the type of treatment that you are receiving. Most often, they will ask whether it is necessary and appropriate. If they feel the duration or extensive nature of your treatment is more than necessary, they might request that you seek an independent medical examination (IME) to prove what your injuries are and whether the care is appropriate. They may even request it to prove that you were injured at all. Sometimes an IME is required before an insurance company will pay for any medical treatment.
What is an Independent Medical Examination
An independent medical examination allows the insurance company to request that you be seen by their preferred physician. They do have the legal right to request that you be examined and that you go to the physician that they choose. If you do not go to the IME, then you might risk losing your workers’ compensation eligibility.
If an insurance company is asking you to seek an IME, then it is an excellent idea to contact The Law Office of James M. Office. We understand how the insurance companies work and can advise you about what your rights and obligations are. The insurance company has the right to require that you seek a second opinion to verify that you were injured, that you were injured to the extent that was diagnosed and to help verify that your injuries were actually work-related and not caused by something else.
Who pays for the IME?
The good news is that although it is a hassle, the insurance company is required to pay for the IME. There are even times when they will have you seek more than one IME if there are conflicting findings, any costs of which would also be the responsibility of the insurance company.
If you are injured while on the job and have been asked to have an independent medical examination, then it is imperative to have a St. Louis workers’ compensation lawyer review your case. There is a great likelihood that the insurance company is trying to find a way to deny coverage. Having someone to protect you is crucial to ensure that you receive fair compensation for your injuries and the treatment that is necessary to make a full recovery.
Questions to Expect from an Independent Medical Examiner
1. How Did You Injure Yourself?
Explain the circumstances surrounding your injury in as much detail as possible.
2. What Are Your Symptoms?
Be prepared to describe your symptoms, including when they started, how they’ve changed over time, and what makes them better or worse.
3. What Is Your Current Pain Level?
The doctor will likely ask you to rate your pain on a scale of 0 to 100, with 100 being the most severe pain imaginable. It’s important to be honest in your answer as this will be used to help determine the extent of your injuries.
4. Have You Been Treated for This Condition Before?
If you’ve seen other doctors for your condition, be prepared to provide information about those treatments. This includes both traditional medical treatments and alternative therapies such as chiropractic care or massage therapy.
5. What Is Your Current Medical Treatment?
Be sure to provide details about any medication you’re currently taking and any other treatments you’re receiving such as physical or occupational therapy.
6. What Are Your Current Physical Limitations?
The doctor will want to know what you can and cannot do as a result of your injuries. This may include things like lifting, bending, sitting, standing, and walking. Be sure to give specific examples of activities that you can no longer do or that are more difficult to do due to your injuries.
7. How Do You Spend Your Day?
The doctor will want to know how you spend your day, both before and after your injury. This includes things like work, household chores, child care, and leisure activities. Be prepared to explain how your injury has impacted your ability to do these things.
These are just some of the questions you can expect from an IME doctor. Remember, it’s important to be prepared for your IME so that you can give the most accurate and complete information about your injury and its impact on your life.
At the same time, remember that insurance companies often hire these doctors to look for ways to deny or minimize benefits. That said, you should prepare well for your IME and know what to expect. Here are additional tips to help you through the process:
- Be honest in your answers, and don’t try to downplay your symptoms. However, in the same light, don’t exaggerate your symptoms or try to make your injury sound worse than it is.
- Be clear and concise in your answers. The doctor will likely have a lot of questions, so try to answer each one as directly as possible.
- Take time to think about each question before you answer. You don’t have to provide an answer right away, and it’s better to take a few moments to consider your response than to give a rushed or inaccurate answer.
- Ask for clarification if you don’t understand a question. Or, if the doctor uses medical jargon you don’t understand, ask them to explain it in simpler terms.
- Don’t offer too much information. The doctor doesn’t need to know every detail about your life, so try to stick to the facts and provide only the relevant information about your injury.
- Have a friend or family member accompany you to the IME. This person can take notes during the exam and provide support and assistance if needed.
4 Things to Watch for During a Workers Comp IME
While an IME can be helpful, it could also be one of the insurance company’s tactics to avoid paying out on a claim. If you’ve been called to complete an IME, there are a few things you should watch out for.
Failure to Attend Could Result in a Denial of Your Claim
While the request to attend an IME may seem like an inconvenience, it’s important to understand that your failure to attend could result in a denial of your claim. The insurance company is entitled to have their own doctor review your case and determine whether or not you are truly injured. If you do not attend the IME, the insurance company will likely deny your claim.
If, for any reason, you’re unable to attend the IME, be sure to provide documentation to your employer and the insurance company as soon as possible.
Don’t Assume That the IME Doctor Is on Your Side
The IME doctor may seem friendly. They may ask about your hobbies outside of work, your favorite sports teams, etc. You might be thinking, “Wow, this doctor is really on my side.” However, it is important to be cautious – just because the doctor seems friendly doesn’t mean they’re necessarily on your side.
The IME doctor’s job is to review your medical records and determine whether or not your injury is work-related. In some cases, the IME doctor may have a financial incentive to rule against you–meaning they could potentially make more money if you’re denied workers’ compensation benefits.
So, while it’s important to be polite and respectful to the IME doctor, don’t assume that they’re on your side.
Don’t Give Too Much Information
As we mentioned, the IME doctor is not your friend, and they’re not there to help you. They’re there to gather information that could be used against you. While you should answer the doctor’s questions truthfully, you don’t want to give them any more information than necessary.
For example, let’s say the doctor asks you how your injury has impacted your life. You might be tempted to tell them about all the different ways your life has changed since the injury. However, it is important to be cautious. The more information you give, the easier it will be for the doctor to find reasons to deny your claim. Answer the question truthfully but briefly.
You Have Rights
The most important thing to remember during your IME is that you have rights. You have the right to refuse to answer any questions that make you uncomfortable.
Work Injury Lawyer St. Louis
Missouri Workers’ Comp enables an injured worker to receive medical benefits as well as income benefits. You should be receiving treatment for ALL of your injuries, not just the ones the insurance company wants to accept. Do not let the carrier deny you benefits.
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