The Truth About Independent Medical Exams

doctor pointing to a computer screen during an independent medical exam

In New York, injured workers seeking benefits must be evaluated and diagnosed by workers’ compensation doctors approved by the employer’s insurance company. In most cases you will be permitted to be treated by your own doctor. However, situations can occur when the insurance company requests an Independent Medical Examination, or IME.

What is an Independent Medical Exam?

Independent medical exams are requested by the workers’ compensation insurance company and performed by a doctor who works for the insurance company. In most cases the adjuster who is assigned to your claim chooses the IME doctor you will be required to see.

The IME doctor is not there to treat you or assist you in dealing with your work-related injuries. The doctor’s responsibility is to study the medical notes and documents related to your claim, discuss your injury, and examine you.

While the insurance company calls it a request, if you refuse an to go to an independent medical exam your case will be denied. An IME is ordered by the workers’ compensation insurance company for several reasons, however the main one is to save them money.

Workers’ comp insurance companies will go to great lengths to save money, which mean limiting benefits and wage payouts to injured workers. If an insurance company has medical proof that you’re able to return to work, they can limit your workers’ compensation.

Other reasons for independent medical exams include:

  • The insurance company disagrees with your doctor’s medical opinion
  • The claim is moving too slowly or getting to expensive, and the insurance adjuster wants it to come to an end
  • Evidence is needed to resolve a dispute about your claim, limit your benefits, or to deny your claim

IME Doctors Work for The Insurance Company

As previously mentioned, IME doctors receive their paychecks from the insurance company. For this reason, many are inclined to protect company profits and forgo recommending expensive treatments. While an MRI or CT scan may be necessary, they’re expensive and can complicate the claim. The doctors would rather not mention the recommended services to the patient to avoid dealing with a controversy with the insurance company.

For this reason, many IME doctors are likely to treat injuries with pain medications rather than recommend surgery, physical therapy, or another necessary type of treatment. The doctors are looking after their best interests and want to remain on the list of workers’ comp referrals. By not verifying the severity of your injuries, they are likely to remain in the insurance company’s good graces.

Protect Your Workers’ Comp Claim

If you feel you are being treated unfairly by the workers’ compensation insurance company or that you aren’t receiving the benefits you deserve, you need to protect your claim as soon as possible!

You have the right to seek a second medical opinion if you feel the workers’ compensation doctor isn’t addressing your medical concerns. Most insurance companies will permit a second opinion; however, it will come from another IME doctor.

You should contact the experts at Erwin McCane & Daly today to discuss your options. With over 30 years of experience, we can guide you in the right direction and ensure you receive the treatment and benefits you need. Give us a call today to schedule you free consultation.