At some point during the Workers’ Compensation process, it is likely that an injured Pennsylvania employee will be required to attend an Independent Medical Examination (IME). An IME is typically conducted by a doctor selected by the employer’s Workers’ Compensation insurer. Workers should understand their rights and be prepared for the examination to ensure they continue to receive the benefits they need.
In theory, an IME is supposed to be an objective assessment of a worker’s medical condition. However, in practice, the employer’s insurer typically requests the IME and selects the doctor to perform it. According to the Pennsylvania Department of Labor and Industry, the purpose of an IME is to show that the work-related injury no longer exists or has decreased in severity. The doctor may therefore not be impartial, as they have an interest in lowering costs for their employer in exchange for receiving future referrals.
The usual confidentiality that comes with a doctor-patient relationship does not apply during an IME. Therefore, any information a worker tells the doctor during the exam may be used against them to either reduce or terminate their benefits. Any inconsistencies the doctor observes may also be included in their report and used to challenge the worker’s credibility.
When an IME is requested, workers must attend or else risk losing their benefits. Those who do not show up for an IME may lose their benefits during the time of the refusal, and future benefits as well. In Pennsylvania, insurance companies may only schedule two IMEs a year, therefore, once a worker has attended one IME, they will not be required to attend another for at least six months.
The insurance company may also draft a letter to the doctor, along with questions regarding the worker’s medical condition. Often, these questions pertain to whether the worker’s condition:
The doctor will review the worker’s medical records prior to the IME, examine the worker, and ask them questions regarding the worker’s medical history, how the injury occurred, and their current course of treatment. The doctor’s written opinion will be reviewed by the Workers’ Compensation Judge, who will make the final determination regarding whether benefits should be modified, suspended, or terminated.
Before the IME, workers should request copies of any documents sent from the insurance company to the doctor, such as medical records, letters describing the injury, and lists of questions. Be truthful during the exam but be aware that the doctor may not have your best interests in mind; therefore, proceed with caution when answering questions about your prior injuries and current limitations. You may need an attorney to help ensure that your rights are protected both during the IME and throughout the claims process.
If you received a request to attend an IME, contact a Philadelphia Workers’ Compensation lawyer at Gross & Kenny, LLP. Our experienced attorneys can help guide you through the process and protect your interests. Located in Philadelphia, we serve clients throughout Pennsylvania. For a free consultation, contact us online or call us at 267-589-0090.
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