As an injured employee progresses through his or her Vermont workers’ compensation claim, it is not at all uncommon for the insurance company or their attorney to schedule you for an Independent Medical Examination (a.k.a. an “IME”). If you’ve never had a workers’ comp injury or filed a lawsuit for other injuries, you’ve probably never heard of or attended an IME. So what is an IME, and what should you expect when you attend an IME? I’ll try to answer some of your questions here.
First things first. There is nothing “independent” about an independent medical examination. Rather, as one Vermont workers’ comp attorney likes to say, the independent medical examiner is “not your friend.” They are hired by the insurance company and paid by the insurance company. The insurance company chooses them in the hopes that they provide an opinion which helps the insurance company defeat or resolve your workers’ compensation claim. The questions an IME examiner is asked to answer can vary, but primarily their role is to provide opinions on whether your injury happened the way you say it happened; whether the treatment you’ve been receiving is reasonable and necessary; whether you should have returned to work by now (i.e. whether you’re milking your injury); whether certain medical treatment proposed by your treating providers, including surgery, is reasonable and necessary (i.e. whether they should have to pay for it); and whether you have reached “medical end result” (i.e. whether the insurance company can stop paying you certain benefits, including TTD). They may also be asked to provide an opinion on your ability to return to the same work you used to be doing, and the extent that your work injury has resulted in any permanent impairment which could entitle you to PPD. Insurance companies often use the same examiners over and over again because those examiners have a reputation for being much more friendly to employers than to injured employees.
So what happens when an IME is scheduled, and do you have to attend it? Generally speaking, you will receive a letter notifying you that an independent medical examination has been scheduled, and when and where it will occur. The letter may come directly from the insurance company or their attorney, but will often come from some third-party vendor you’ve never heard of. That company finds the examiner, schedules the examination, sends them your medical records, and types up the examiner’s written report.
Unfortunately, you don’t have much say in whether you attend the IME. The insurer is simply required to give “due regard” to your schedule and ability to travel, and must provide you with notice of the IME at least 7 days before it is scheduled. Under Vermont law (21 V.S.A. 655), a workers’ compensation claimant is required to “submit to examination, at reasonable times and places, by a duly licensed physician or surgeon designated and paid by the employer.” If you do not attend, the insurance company can stop paying your Vermont workers’ comp benefits. They will almost definitely discontinue your weekly TTD benefits and may stop paying medical benefits as well. If you’re unsure whether to attend an IME, please don’t hesitate to give me a call and I will try to help you determine whether the IME is reasonable.
So, what happens at the IME? First of all, you are allowed to bring a friend or family member with you if you’re uneasy about the examination or just want a second set of eyes there with you. You’re also allowed to make a video or audio recording of the IME as well. When you arrive, the examiner will most likely have you fill out a number of questionnaires and/or take certain “tests” meant to evaluate the extent of your injury and your state of mind (such as whether you view yourself as disabled, depressed, etc.). The examiner will eventually meet with you and may go over your medical history, together with any medical records related to your injury. It is important that you are honest with the examiner about any prior injuries, and that your descriptions are consistent with what you have told your own medical providers. The examiner will then perform a physical exam, which could be limited to your specific injury but may include a more generalized exam as well. In some instances, the examiner could make some helpful recommendations for treatment that hadn’t been suggested before. Again, however, keep in mind that the examiner is being paid by the insurance company and, despite how trustworthy and friendly they may seem, he or she is not “independent” and has different priorities than your treating provider. It is not uncommon for an IME expert to tell an injured employee one thing at the examination, but then write something completely different in his or her written report. Thus, take what they say with a grain of salt, but feel free to discuss their recommendations with your own providers.
After the IME has concluded, the examiner will prepare a written report and will send it to the insurance company or their attorney. The insurance company is required to provide you with a copy. Read it carefully or consult with an attorney to discuss it. Depending on the examiner’s conclusions, there is a realistic possibility that the insurance company will file certain forms with the Department of Labor, seeking to discontinue or deny various workers’ compensation benefits or medical treatment. If that occurs, you will likely want to hire a lawyer to ensure that your rights and benefits are protected.