Independent Medical Exams (IME) in Workers’ Comp Cases in Pennsylvania
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 Specialists 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.
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”. It proves that medicine is an art- not a science.
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 PA Work Comp Law.
Who Hires 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.
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. 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. Fortunately, they cannot require you to go get another IME too frequently, and our Pennsylvania Workers’ Comp lawyers can advise you on every step of the way with your IME.
When Do IMEs Start
IMEs are sometimes used in contested cases earlier on 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.
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.
These exams are different from the normal diagnosis and treatment process of getting care for a work injury. While your employer’s insurance carrier may have a list of chosen doctors they use to see what condition or injury you have, recommend treatment, and carry out a treatment plan, the entire purpose of an IME is to have a separate doctor look at you, not your treating physician.
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. 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. Moreover, one IME might not be one visit.
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.
If you don’t attend, the most likely consequence is that the insurer will file what’s called a Petition to Compel. This means they petition the Judge to issue an Order compelling you to attend the next exam, otherwise, your wage loss checks can be suspended absent good cause. If you fail to follow that court order, then they can file to have your benefits stopped entirely.
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. 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.
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.
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. Many injured workers need to hire medical transportation just to get you to the IME, which can be expensive. If your disability allows you to still work to an extent, you may also need to take a day – or multiple days – off of work to go to the exam. In any case, all of these expenses should be paid by your employer.
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. 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.
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.
Treating Physician vs Independent Medical Evaluator
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”. 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. 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 PA 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- the way in which the incident or injury occurred. (i.e., heavy lifting loads the discs in spine). I always try to point out that my clients underlying degenerative joint disease (which we all have, if you are over 25 years old) was NOT symptomatic prior to the work injury, and so, to attribute my clients’ complaints to this makes no sense.
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. They are notorious for calling an injury a “sprain” or “strain” and blaming all your issues on “arthritis”.
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. There are not many objective signs of an injury- other than diagnostic studies- which can also be subject to much debate as well (i.e., EMG studies in particular). 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. IME physicians will often explain away herniations in the spine, as degenerative in nature, or not traumatically induced, whereas 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.
Call Our Workers’ Compensation Lawyers in Pennsylvania Today
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 who is likely to pick the same doctors who routinely find everyone magically recovered? If you have any thoughts, please share them.
If you are scheduled for an Independent Medical Exam, and don’t yet have an 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.
Call Cardamone Law’s Pennsylvania Workers’ Compensation attorneys at (267) 651-7945 today for a free review of your case.
