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There is a huge trust deficit when it comes to Pennsylvania’s injured workers and doctors who perform independent medical examinations (IMEs).
Not many people believe that these exams are independent or in the best interest of the injured workers. A major reason for this is the fact that the work comp insurance carrier/employer gets to handpick whomever they wish to examine the injured worker.
Their goal is to garner an opinion that the injured worker is either fully recovered, or at least to minimize their restrictions. Sometimes, IME doctors even challenge the diagnoses of the treating physician and claim that it isn’t work-related.
Understandably, injured workers feel a lot of apprehension going for IMEs.
However, the good news for injured workers is that the IMEs often lead to litigation which can then mean getting their case settled for a lump sum compensation. Albeit it happens sometimes, yet in cases where things seem to be at a standstill, the independent medical exam can get things moving.
The bad news is the medical opinions in IME reports can cause great stress and worry among injured workers. To hear that they are suddenly recovered, and that they are “malingering” is a tough pill to swallow. The natural reaction is anger. But I always remind our clients that they know the truth and we know the truth and that we’ll have a good chance at demonstrating to the Judge that the IME doctor’s opinions are not credible.
Thank God for Due Process — the ability for each side to present their evidence. In most cases, our clients tell us the exam was shallow: 10 minutes, tops. Plus, usually, the physician has an attitude that injured employees do not find very helpful.
Granted, it doesn’t mean that their treating physician is spending an hour with them. But when you have one bite at the proverbial apple, you would think the physician would ask a lot more questions and perform longer exams.
The upside of this is the deposition. We get to expose the fact that the doctor had one shot and didn’t ask this or didn’t ask that, etc.
Do injured workers have to attend the Independent Medical Examinations? Generally speaking, yes. The rule of thumb is that the exam can take place every 6 months or so. Sometimes there are exceptions to this. The consequence for missing the exam is likely going to be a Petition to Compel, filed by the insurance company’s attorney. This petition seeks a Court Order from a Pennsylvania Workers’ Compensation Judge to compel the injured worker to attend the next examination. If they don’t, that wage loss benefits, if applicable, will be suspended.
Remember, if you drive yourself to the exam, you can get reimbursed for miles and tolls/parking. If you want the insurance company to arrange transportation for you, let us know (if we represent you) ahead of time or whomever your attorney is.
What are some of the common ways the Independent Medical Doctors undermine injured workers?
One common method is to spy on them as they walk into the building, then later claiming they walked differently in the office.
Another dynamic we often see is blaming the physical condition on “age-related” findings or “arthritis”. Indeed, arthritis may be the single biggest reason there is so much litigation in America in Work Comp, Personal Injury, or Medical Malpractice cases. A doctor can always hang their hat on this, that the MRI findings didn’t occur from the event, but from aging.
They’ll say this sometimes even when an injured worker is in their 20s.
In other cases, we read that the injured workers’ examination didn’t make sense, because they couldn’t do one maneuver, but when “distracted”, they could do it without any issues. And the most popular claim? “There are no objective findings to support the subjective complaints”. When you dig deep in a deposition with some of the IME doctors, they will tend to stumble over what objective findings could have been present. That’s a story for another day.
We need balance in the system. The insurance companies are paying the benefits ultimately, so we aren’t arguing for no checks and balances. But the idea that these exams are objective or independent is a farce in the majority of cases.
To maximize compensation benefits for injured workers, educating our clients is essential so they know how the process works, and to prepare them mentally for the opinions that may soon be rendered about them. That being said, attending with an open mind, with 100% honesty, and without a chip on the shoulder, is the way to go. Don’t change yourself or how you behave just because you suspect the doctor may be biased and trying to take food off your table. Authenticity rules the day.