Introduction

An Independent Medical Examination (IME) is a crucial step in a workers' compensation claim. Unfortunately, the results are not always in the injured worker's favor. If you have received an unfavorable IME report, it can have serious consequences for your benefits, including denial or reduction of compensation. However, you have options to challenge or mitigate the impact of a negative IME.

This comprehensive guide explains what an IME is, why it might not be favorable, and most importantly, the steps you should take to protect your rights after receiving an adverse IME report.

What Is an Independent Medical Examination (IME)?

An Independent Medical Examination (IME) is a medical evaluation requested by your employer's workers' compensation insurance company. It is conducted by a doctor who is not your treating physician and is supposed to provide an unbiased medical opinion on your condition.

Why Is an IME Required?

An IME is often requested when:

• The insurance company wants to verify your injury.

• There is a dispute about your treatment plan.

• Your employer's insurer suspects you can return to work.

• There are questions about whether your injury is work-related.

Why Do IMEs Often Favor Employers and Insurers?

While IMEs are supposed to be independent, they frequently lean in favor of the insurance company. This happens because:

• The IME doctor is hired and paid by the insurer.

• IME doctors regularly work with insurance companies.

• The insurer may use selective wording to influence the IME doctor's conclusions.

• IME reports often downplay the severity of your injury.

Signs of an Unfavorable IME Report

An IME report may be considered unfavorable if it:

• States that your injury is not work-related.

• Claims you have fully recovered and can return to work.

• Suggests that your medical treatment is unnecessary.

• Disputes the severity of your pain or functional limitations.

If any of these findings appear in your IME report, your workers' compensation benefits may be reduced, modified, or denied altogether.

What To Do If You Receive an Unfavorable IME Report?

1. Do Not Panic

Receiving a negative IME report can be frustrating, but it is not the final decision. There are several ways to challenge and counter the IME findings.

2. Obtain a Copy of the IME Report

Request a full copy of the IME report from your employer's insurance company. Carefully review it to identify errors, inconsistencies, or biased statements.

3. Continue Following Your Treating Doctor's Advice

Your treating physician's opinion holds significant weight in your case. Do not alter your treatment plan based on the IME report alone.

4. Compare the IME Report with Your Treating Doctor's Findings

Identify the differences between the IME doctor's conclusions and your treating physician's assessment. If your treating doctor disagrees with the IME, their medical opinion can be used as evidence to challenge the unfavorable report.

5. Request a Second Opinion

Depending on your state's workers' compensation laws, you may be entitled to a second opinion or an independent medical review by another doctor.

6. File a Formal Objection

If the IME report is being used to reduce or deny your benefits, you can formally object. Your lawyer can help you file the necessary paperwork and present evidence contradicting the IME findings.

7. Gather Additional Medical Evidence

To strengthen your case, collect:

• Medical records showing your ongoing treatment.

• Diagnostic test results (MRI, X-rays, CT scans) supporting your injury claim.

• Statements from your treating doctor disputing the IME findings.

• Testimonies from specialists who can validate your condition.

8. Consider a Functional Capacity Evaluation (FCE)

A Functional Capacity Evaluation (FCE) is a specialized assessment that measures your ability to perform work-related tasks. This objective testing can counter the IME doctor's claims that you are fit to work.

9. Hire a Workers' Compensation Lawyer

An experienced workers' compensation attorney can challenge an unfair IME report by:

• Cross-examining the IME doctor.

• Highlighting biases in the IME report.

• Presenting compelling medical evidence to dispute the findings.

• Advocating for your benefits at a hearing or appeal.

10. Prepare for a Workers' Compensation Hearing

If the insurance company refuses to reconsider your benefits after an unfavorable IME, your case may go to a workers' compensation hearing. Your attorney will present medical evidence, witness testimonies, and expert opinions to challenge the IME report.

How Can You Avoid an Unfavorable IME Outcome?

Before the IME Appointment

• Be prepared: Review your medical history and treatment details.

• Be honest but concise: Stick to the facts without exaggeration.

• Stay professional: The IME doctor is not on your side, but avoid hostility.

• Take notes: Document what happened during the appointment.

• Bring someone with you: A witness can help if there are discrepancies in the IME report.

After the IME Appointment

• Write a summary of what the doctor asked and how you responded.

• Follow up with your treating doctor to discuss the IME findings.

• Consult with an attorney if you suspect bias in the IME report.

Conclusion

An unfavorable IME report does not mean the end of your workers' compensation claim. By taking the right steps—reviewing the report, obtaining a second opinion, gathering medical evidence, and consulting an experienced workers' compensation attorney—you can effectively challenge the IME findings and protect your benefits. Do not let an insurance company's hired doctor dictate your future. Take action to defend your rights and ensure you receive the compensation you deserve.

Frequently Asked Questions (FAQs)

1. Can I Refuse to Attend an IME?

In most cases, no. If you refuse to attend an IME, your workers' compensation benefits may be suspended or denied. However, you can challenge an IME if the doctor is not truly independent or qualified.

2. How Can I Prove the IME Doctor Is Biased?

You can demonstrate bias by:

• Showing the doctor frequently works with insurance companies.

• Identifying inconsistencies in their past IME reports.

• Comparing their conclusions with objective medical evidence.

3. Can I Request a Different IME Doctor?

In some states, you may have the right to challenge the selection of the IME doctor if you can prove potential bias or lack of qualifications.

4. How Long Do I Have to Dispute an Unfavorable IME?

The timeframe to dispute an IME varies by state, but you should act immediately to avoid delays in your benefits.

5. Can My Employer Use an IME to Force Me Back to Work?

An employer cannot force you to return to work solely based on an IME. However, if the IME report states that you are fit to work, your benefits may be reduced or terminated, making it critical to challenge unfair findings.

By following these steps, you can effectively fight back against an unfavorable IME and protect your workers' compensation rights.