Can I Get Reimbursed for Miles Traveled to an IME?

Independent medical examinations (IMEs) are required appointments with a so-called “neutral” or “independent” doctor to examine your medical condition and check that you are still as disabled as you claim to be.  This is an important part of your Workers’ Compensation claim and can make or break whether you are able to keep getting benefits, but these reviews are quite an interruption and might even be far from your home.  If the insurance company is the one requiring this IME, can you get reimbursed for going to it?

Reasonable travel expenses for an independent medical exam should be covered by the insurance carrier that demanded it.  This means that your employer’s carrier should reimburse you for any mileage to attend the IME, and if you needed specialized medical transport, that should also be covered.  In many cases, you can also contact the insurance carrier and have them arrange transportation for you.  The insurance carrier also has to reimburse you for any lost wages to attend the IME.

For help with your Workers’ Comp claim, call the Certified Pennsylvania Workers’ Compensation Lawyers at Cardamone Law today at (267) 651-7945.

What is an IME and When Do they Happen in a Pennsylvania Workers’ Comp Claim?

When you are seeking coverage for your work injuries, the ideal outcome is that your employer’s insurance carrier pays for all medical care and for wage-loss benefits while you are out of work or on reduced wages for light-duty work.  As part of a total disability claim, the insurance carrier is permitted to request an independent medical exam (IME) to prove that your condition is what you say it is as you draw on benefits for a prolonged period.

Contested claims might include an IME to have an “independent” doctor review your condition and see that you are unable to work.  These IMEs usually come after you have already been on total disability benefits for 104 weeks (i.e., 2 years).  At that point, the insurance carrier is allowed to request an IME every 6 months (i.e., twice in a 12-month period).

The insurance carrier – not you – has to pay for this IME.  Additionally, while they are called “independent,” remember that the doctor doing the review is essentially working for the insurance carrier, and their whole role is to look for any evidence the insurance carrier can use to take you off benefits.

The determination the IME doctor makes might require scans, tests, and physical examinations.  If the insurance carrier and Workers’ Comp judge determine that you are no longer disabled, they can kick you off your benefits, and you may have to go back to work.  They can also determine you are only “partially” disabled now and reduce your benefits.

If you are still deemed disabled, then your benefits can continue.  You can work with our Philadelphia Workers’ Compensation lawyers ahead of your IME to review what you should and should not do or say, and you can also seek (and pay for) other exams of your own to try to counter what the IME finds.

Do I Get Reimbursed for Going to an IME in Pennsylvania?

The cost of the IME, including any tests or scans, should be covered by the insurance carrier.  Along with this, the cost of attending the IME should also be covered.  Specifically, § 314 of the Workers’ Compensation Act specifically requires the employer to pay for the examination, the “reasonable traveling expenses,” plus the “loss of wages” you face.

This means that it should cost you nothing to go to the IME doctor – but remember that the insurance carrier is paying them and that their role is essentially to find evidence to kick you off benefits.  You can choose to pay for your own doctor, who can counterbalance the IME doctor and truly provide an “independent” view of your injury.  If you do want your own review from another doctor, you will have to pay for that.

Keep in mind that this IME doctor is separate from the doctor treating you.  The insurance carrier has to pay for that doctor as well as part of your Workers’ Comp benefits.

Travel expenses should be covered, but the law specifically calls for “reasonable” expenses.  This usually means reimbursement in the form of a mileage reimbursement rather than the specific cost of gas, wear, and tear on your specific vehicle.  However, if you need additional transportation needs – like a medical transport van – that should be covered.

If you are working to some extent and you have to miss work to attend your IME, that should also be reimbursed.  This means getting your wages for the day paid.

In some cases, IMEs might actually require more than one visit if the IME doctor cannot complete the review or follow-up tests and exams are required by the judge.  As such, transportation costs might be more than you expect, and it is important to get them covered.

Arranging Transportation with Your Insurance Carrier for IMEs in Pennsylvania

Getting reimbursement is not the only way to get your transportation needs covered.  Many insurance carriers understand that the claimants and injured workers they are dealing with have severe injuries and long-term disabilities that might make it harder to travel to their IME.  If you use a wheelchair or mostly stay in bed because of your injury, you might need more sophisticated medical transportation to get you to the IME.  Additionally, a lot of disabled people simply do not drive anymore and might need a ride.

Most insurance carriers are willing to arrange transportation and provide a way for you to get to your IME.  Our lawyers can interface with them and help make sure transportation is arranged and paid for as part of the IME if you need it.  If the insurance carrier fights us on this, we can have a judge intervene and see to it that your transportation gets covered so that you can carry out your obligations and attend the IME as required.

Call Our Pennsylvania Workers’ Comp Lawyers Today

Call Cardamone Law at (267) 651-7945 for a free case assessment with our Bensalem, PA Workers’ Compensation lawyers today.