After being injured at work it’s important to follow the steps for filing a workers’ compensation claim. Ideally an employer’s workers’ comp insurer will pick up the costs of the employee’s medical care from the first visit to a doctor until the injury has healed. In reality, though, insurers work hard to limit their exposure to costs related to covered injuries. One way they try to do this is by arguing that the injury is not as significant as the employee claims. This risk can be mitigated by having an attorney present during medical exams.
After receiving a claim for benefits an insurer has the right to require the injured worker to submit to an independent medical examination, or IME. The formal purpose of the IME is to ensure that the insurer is basing its coverage decisions on a reliable and supposedly neutral diagnosis by a physician other than one with which the patient may already have a relationship. In reality insurers often request an IME because they disagree with an initial diagnosis, or have doubts about whether an injury is related to the worker’s job.
The state maintains an official list of physicians who are authorized to perform examinations of work-related injuries. Insurers are very familiar with the doctors on this list. They know who has a history of providing insurer-favorable diagnoses and will steer unwary patients to those doctors whenever possible. When a worker is told to attend an IME, the insurer may provide a limited list of doctors to choose from for the examination. The worker is required to attend the IME, but has the right to request a second opinion from another state-approved doctor if the outcome of that initial exam is not satisfactory.
The IME is potentially one of many “independent” examinations that the patient will undergo over the course of a workers’ comp claim. For example, if the injury results in a permanent partial disability the extent of the disability will need to be evaluated by a physician who is specifically trained in how to do this.
The extent to which a patient needs to have an attorney present at a medical exam will depend on the nature of the injury and the extent to which facts about the injury are in dispute. An attorney can help the patient decide whether having an attorney or other witness on-hand is advisable, but as a general rule it is better to have a witness along than to go alone. The witness can take notes about the examination and may provide important testimony in the event that the results of the exam need to be disputed in a later proceeding. Note that some physicians may claim to have a rule prohibiting others from attending these exams. This should raise concerns that the exam may not be fair, and should be disputed.
For more than 45 years the law firm of Greenman Goldberg Raby Martinez has helped injured workers get the coverage they deserve. If you have been injured at work, our experienced injury attorneys are standing by to offer advice about your case. Call us today for a free attorney consultation at 702-388-4476 or reach us through our contact page.