Independent medical examinations (IMEs) are used by Workers’ Comp insurance carriers to have an expert look at you and your condition to see how bad it is and whether you are still dealing with a valid injury that should get you Workers’ Comp benefits. These exams can be a big hassle for injured workers and are usually used solely to benefit the insurance carrier, but fortunately, they cannot happen that often.
Under the Pennsylvania Workers’ Comp Act’s § 306(a.3)(6), they cannot have you submit to more than two IMEs in a 12-month period. This means you can be asked to do an IME, at most, once every 6 months. Understanding when these exams pop up in your case and how they are used to shut down your benefits is important, and you should always speak to a lawyer before attending an IME.
For help, call the Certified Pennsylvania Workers’ Compensation Lawyers at Cardamone Law today at (267) 651-7945.
How Do Independent Medical Exams Work for Pennsylvania Workers’ Comp?
If you receive a notice scheduling you for an Independent Medical Exam, you should speak to your Philly workers’ compensation attorney about whether you need to attend. The general rule is the insurer can schedule one every 6 months or so. There are some exceptions where more than one can be scheduled in a 6-month period.
The Exam
An independent medical exam doctor in Pennsylvania will typically spend 5 minutes examining an injured worker in Pennsylvania, and many times they issue a report stating the injured worker is “fully recovered” because there aren’t “objective findings” to support the “subjective complaints.”
What to Do During an Exam
When you attend an IME, you want to be on time, honest, and as detailed as possible about whatever you are asked. Make sure you have a complete handle on any similar pre-existing injuries as you will surely be asked. An aggravation of a prior condition is still a work injury under Pennsylvania Work Comp Law.
Are IMEs Required?
IMEs are not required in every case, but insurance carriers are entitled to use IMEs at the times the law allows it, and you are not allowed to refuse. If you do, they can file for a court order to make you go.
What Happens When You Refuse an IME in Pennsylvania?
If you don’t attend, the most likely consequence is that the insurer will file what’s called a Petition to Compel.
Petitions to Compel
When an employer files a Petition to Compel, they essentially ask the Judge to issue an Order compelling you to attend the next exam. If you still don’t, your wage-loss checks can be suspended unless you have a good excuse.
Suspension, Termination of Benefits, and Claim Dismissal
If you refuse to participate in an IME, your benefits will be halted until you comply. If you continue to refuse and fail to follow that court order, then they can file to have your benefits stopped entirely.
If you are in the early stages of getting your Claim Petition granted, failing to submit to an IME could mean the Judge dismisses your Claim Petition, and your case is over.
Fighting an IME
The fact that an IME is required doesn’t mean you can’t fight negative results or harassment from an IME. Your lawyers have options to help you:
- Countering bad IME results with outside doctors’ opinions
- Getting the IME doctor changed if there is a conflict of interest
- Stopping additional IMEs requested ahead of schedule.
When Do You Have to Go to an Independent Medical Exam (IME) for Workers’ Comp in Pennsylvania?
IMEs are used by insurance companies to check on your symptoms and condition and check that you are, in fact, as injured and disabled as you claim to be.
Required Timing
These are often required in contested Workers’ Comp claims, and the insurance carrier will use them whenever they can to try to stop your benefits.
Frequency
Fortunately, they cannot require you to go get another IME too frequently, and our Altoona, PA Workers’ Comp lawyers can advise you every step of the way with your IME.
Patient Rights
It is important to understand what rights you have when walking into an IME
Right to an Attorney
You have the right to speak with your lawyer before the IME, but you usually cannot have your lawyer present in the room during the IME.
Can You Bring Another Person?
You can usually bring an aide or family member, especially if you need them to help you get around, respond to questions, or to translate. However, doctors may be able to refuse them entry into the actual exam room.
Can You Record?
There usually aren’t any concerns about HIPAA or medical privacy, since everything from the exam is going into a report to the court anyway. As such, you should be allowed to record the exam, but the doctor might not allow it.
Make sure to let the doctor know instead of recording secretly, as Pennsylvania is a “two-party consent state” for recording conversations.
How to Prepare for an IME
Before you walk into the IME, you should take these steps:
Arrange Transportation if Needed
You may be able to arrange to have the Workers’ Comp insurance carrier transport you to the exam, especially if you need an ambulance or other specialized transportation. You can arrange this ahead of time so you don’t have to rush around last minute to look for transportation.
Confirm Your Appointment
Similarly, you should ensure you have the right date and location for the appointment so you do not miss it or waste your time going to the wrong location or on the wrong day.
Talk to Your Lawyer Before
Your Reading, PA Workers’ Comp lawyer can answer any questions you have about the exam and what you should/should not do or say.
What to Bring
Bring any medical records or notes you think you might need to reference to answer the doctor’s questions about your condition, when it started, how it affects your daily life and ability to work, etc. Also be prepared to be gone for the day and bring anything you might need, such as a snack, disability aids, or a book to read in the waiting room.
What Should I Do/Say During an IME?
You should confirm with your lawyer on a case-by-case basis, but the following are good tips about what to do and what not to do during an IME:
Tell the Truth – No Lies or Exaggerations
Always tell the truth about your abilities and condition, even if you think it might hurt the case. Do not lie or exaggerate with the hope of getting your claim approved; lies will often be uncovered with medical evidence and hurt your credibility before the Judge.
Do Not Provide Extra Information
Only answer the doctor’s questions. Do not take the extra time to provide additional information the doctor didn’t ask for unless your lawyer advised you to make sure certain information is provided.
Cooperate
Do not put up defenses or try to keep the IME doctor from getting the information needed for the exam. This could require you to come back for a second appointment or prevent the Judge from getting all of the information needed to decide your claim.
When Do IMEs Start?
IMEs can take place at multiple points in your claim:
Initial IME
IMEs are sometimes used in contested cases earlier than you might expect. These early IMEs are primarily used, frankly, to have the insurance carrier’s own chosen doctors analyze your condition and gather evidence that the insurance carrier can use against your claim.
Later Reviews
In other cases, IMEs are used after you have already been on total disability benefits for 104 weeks (i.e., 2 years). At this point, the insurance company can make you go get an IME periodically to make sure you are still disabled. If, during one of these exams, your disability seems improved, they may be able to reduce your benefits; if the disability is healed, they can stop your benefits.
Partial vs. Total Disability
If you are on total disability, you will remain on total disability until an Impairment Rating Evaluation (IRE) finds that your whole-body impairment rating is under 35%. At that point, your benefits will be converted to partial disability benefits, which only last for 500 more weeks.
An IRE may be performed at the same time as an IME, but they are different exams with different goals:
- The IME determines your medical status for qualifying for disability.
- The IRE determines your impairment rating only for partial vs. total disability status.
Disability status doesn’t change the fact that you can still be asked to attend an IME twice a year, and none of this changes your benefit rate unless you actually return to work.
What if My Employer Requests Too Many IMEs?
Your employer only has the right to ask for two IMEs per year. If they ask for more, your employer can advise you on how to refuse the exam.
In any case, they will not be able to force you to go to the additional IMEs, as they have no right to request them. Moreover, your employer will not be able to succeed in a Motion to Compel, and a Judge will not order you to attend an IME that the employer has no right to ask for.
How Often Do I Go to an IME?
An insurance carrier cannot ask you to do more than two IMEs in a 12-month period – meaning two per year or one every 6 months.
Reasoning
This prevents them from being able to harass you by requesting repeat exams at an unreasonable schedule. Even so, every 6 months might be a hassle, especially if you have to travel pretty far and take time off work to get to the exam.
One IME Might Mean Multiple Visits
Moreover, one IME might not be one visit.
How Many Visits is an IME in Pennsylvania?
Although we refer to these as an independent medical exam – implying there is one exam – many IMEs require multiple visits to the examining doctor.
Health Conditions Might Require Multiple Exams
Depending on your health condition or injury, it might be difficult for the IME doctor to do the whole exam all in one appointment. In many cases, they try to be accommodating and get you in, take any scans they need to, run any tests they need, and get the results in one day, but this is not always practical for some injuries, conditions, and tests.
The Judge Might Need More Information
Sometimes, the Workers’ Comp judge handling the case needs additional information or evidence, and § 314 of the Workers’ Comp Act allows them to order you to get “further” examinations. For example, if the IME doctor’s report comes back and shows that the X-ray of your injury site was blurry, and thus the doctor’s results are inconclusive, the Judge can have you go back and get another X-ray.
Multiple Appointments Still Count as One IME
This “further” treatment is still part of the previous exam and is not a “new” IME that has to be spaced out 6 months from the previous one. While most health conditions are not going to require you to go back and forth over and over again within each 6-month period, it is possible that your total number of trips to the IME doctor(s) could be more than two per year.
Am I Paid for the Hassle of Going to an IME Under Pennsylvania Workers’ Comp?
Taking the time to drive to an IME can be expensive and take a toll on you, especially if your health condition is very severe.
Transportation Arrangements and Costs
Many injured workers need to hire medical transportation just to get you to the IME, which can be expensive. Under §§ 306 and 314 of the Act, an IME – as well as the transportation costs and lost wages to attend the IME – should all be paid for by the employer.
Insurance carriers may even be able to arrange transportation for you rather than making you figure out how to get to the IME they demanded and then paying you back for it later.
Reimbursement for Mileage Traveling to IMEs
You can also be reimbursed for the mileage required to travel to the independent medical exams. Or, alternatively, you can ask that the insurer provide transportation to and from the IME.
Wages for Missed Work
If your disability allows you to still work to an extent, you may also need to take a day or multiple days off work to go to the exam. In any case, all of these expenses should be paid by your employer.
The Burden on Employers Might Reduce Number of Appointments
Essentially, they are the ones putting you through this additional testing, and they have to pay for it. This might also give them an incentive not to bother with each and every exam they could put you through, given the additional expense they will incur to get you there.
IME Doctors vs. Panel Doctors for Workers’ Comp
These exams are different from the normal diagnosis and treatment process of getting care for a work injury.
Panel Doctors
While receiving medical treatment in the first 90 days of your care, your employer should have a list of chosen “panel doctors” they use to treat you. These doctors will see what condition or injury you have, recommend treatment, and carry out a treatment plan.
IME Doctors
The entire purpose of an IME is to have a separate doctor look at you, not your treating physician. This doctor will also be chosen by your employer, but the goal of the exam is totally different, as is the nature of their relationship to you.
Who Are IME Doctors?
In just about every workers’ compensation claim in Pennsylvania, a Claimant will be examined by an “Independent Medical Examiner”. As most practitioners know, these examiners are not “independent.”
Hiring
Instead, they are hired by the insurance companies/employers. An insurance company is permitted, under the Pennsylvania Workers’ Compensation Act, to have a Claimant examined by an IME physician every 6 months.
Goals
The IME physician examines a Claimant, reviews medical records and issues a report as to the disability status, ability to work and causal relationship between any diagnoses and the accident/injury at work. The IME physician often disagrees with the findings and opinions of the treating physician.
How Your Treating Doctor Can Help Strengthen Your Pennsylvania Work Comp Case
Luckily, most Workers’ Compensation Judges in Pennsylvania will credit the treating doctor’s opinions, so long as the claimant’s symptoms can reasonably be explained by the mechanism of injury (i.e., the way in which the incident or injury occurred.)
How to Respond to the IME Physician Report
These exams are usually the beginning of litigation, and often a workers’ comp settlement thereafter. Many of these physicians will see things differently than the treating doctors. For example, they are notorious for calling an injury a “sprain” or “strain” and blaming all your issues on “arthritis”.
Understanding Differences in IME Report
Many Claimants experience a rude awakening when the IME physician drafts a report stating they are “fully recovered” and can return to work without restrictions.
I try to explain to my clients that the IME physician in Pennsylvania is entitled to render this opinion if he believes that there isn’t any objective evidence to support the subjective complaints. It is a rather academic approach to, what is in my opinion, a very subjective matter.
Challenging the Report’s Evidence
There are not many objective signs of an injury- other than diagnostic studies – which can also be subject to much debate as well, especially with EMG studies. Some objective signs of an injury could be swelling, atrophy, paresthesia (numbness), cold or hot temperatures, or color changes.
However, in many cases, such as cases involving a back injury, it is quite difficult to objectively assess a Claimant’s condition, and tough to figure out whether there is objective evidence supporting the symptoms.
Challenging Cause of Injuries
IME physicians will often explain away injuries as happening over time instead of from an accident. E.g., with herniations in the spine, they may say they are degenerative in nature, not traumatically induced. On the other hand, a treating doctor is more inclined to relate a herniation and any complaints to the work injury.
In the same regard, a treating physician will often opine that the work injury aggravated or accelerated the underlying degenerative changes found upon MRI testing. Not surprisingly, the IME physician will attribute the claimant’s symptoms to the underlying degeneration rather than the work injury.
Are IME Doctors Necessary?
We do need balance in the system, and for that reason, IME physicians serve an important function. However, is there a better way to create the balance we need?
What if the Judges were to appoint a doctor to examine a Claimant rather than the insurance company that is likely to pick the same doctors who routinely find everyone magically recovered?
Do I Need a Lawyer Before Attending an IME?
If you are scheduled for an Independent Medical Exam and don’t yet have a Bethlehem Workers’ Comp attorney to help you, call us right away. This is the time to get things in order, as it is very common to see a Petition to Terminate, Suspend, or Modify soon after you attend an Independent Medical Exam.
FAQs for IMEs in Pennsylvania Workers’ Comp Claims
What is an IME?
IME stands for Independent Medical Exam. This is an exam your employer asks for to have their doctors examine your disability.
Who Pays for the IME?
Your employer pays for the IMEs, plus the cost of transporting you there and any wages you miss to attend the IME.
If we need to hire another doctor to counter negative findings in the IME, your lawyers can typically pay for those appointments and get reimbursed when we win your case.
Who Chooses the Independent Medical Doctor in an IME?
IME doctors are hired by the insurance company and tend to see things differently than a Claimant’s treating doctor.
Is the IME Doctor “My Doctor”?
Independent Medical Exams do not create a doctor-patient relationship. The independent medical examiner will examine you, review records, and write a report and send it to the adjustor. The doctor will not tell you their opinions about whether they think you’re recovered or not, or what restrictions you need. That info will be in the report.
Can I Choose the IME Doctor?
You cannot typically object to the IME doctor unless you can point to something like a conflict of interest, past abuse, or a personal relationship that might compromise their judgment or your safety.
How Many IMEs Can They Make Me Go To?
An IME usually takes place at the beginning of your case, then once every 6 months after the 2-year mark. There is no cap on the number of IMEs, and IMEs can happen twice a year for as long as you stay on benefits.
Some IMEs may also be multiple appointments, making this a long process.
How Can I Stop IMEs?
Your employer can file to challenge IMEs if the employer asks for too many in a year, uses a biased doctor, or otherwise acts outside of their rights. You also do not need to continue with IMEs going forward if you settle your claim in a “global settlement” that pays your medical and wage-loss benefits.
How Long Does an IME Take?
The appointment could take all day with travel and wait times, but the exam itself will vary. Some IME doctors might spend a basic 5 minutes on the exam, while others will potentially take an hour or more of in-depth examination.
What Does the IME Try to Find Out?
The doctor’s goal in the IME is usually to find excuses to help your employer deny your claim. They will look for holes in your story as well as any excuse to say your injury is healed or that it is not disabling.
Is My Doctor Different from the IME Doctor?
The treating physician who provides your medical care is different from the IME doctor. In the first 90 days of treatment, your treating physician usually comes from a list of “panel doctors” your employer provides, and your employer pays for the IME doctor.
Even though your employer chooses and pays for both of them, these are different doctors.
Can My Lawyer Come to the IME?
Lawyers usually do not attend IMEs.
Can I Get in Trouble for Lying to the IME Doctor?
You should never lie during an IME. Not only will this hurt your credibility before the Judge, but it can have additional consequences.
Can I Reschedule an IME?
If you have a scheduling conflict or cannot attend because your injury is flaring up, you may be able to get the appointment rescheduled. However, you should notify the insurance carrier and get the appointment rescheduled as soon as possible rather than skipping the exam.
Can I Get in Trouble for Skipping an IME?
If you do skip the appointment, the employer can ask the Judge to order you to attend and potentially pause or cancel your benefits if you continue to skip appointments.
Call Our Workers’ Compensation Lawyers in Pennsylvania Today
Call Cardamone Law’s Allentown Workers’ Compensation attorneys at (267) 651-7945 today for a free review of your case.
