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Injury Claim Basics: The Independent Medical Examination

Injury Claim Basics: The Independent Medical Examination

We all rely upon doctors and other trained healthcare providers to give us their professional opinions about our health. We rely on these recommendations to make decisions that will benefit ourselves and our families. If you have been injured in a work-related or auto accident, your doctor’s opinion will become even more important. What your doctor says can severely impact your ability to perform your job and interact with your family and friends.

But you’re not the only one who relies on your doctor’s decisions. If you were injured at work or in an auto accident, the insurance company that provides you coverage will also rely on your doctor’s opinions in order to make benefits available to you. However, in the long term, the insurance company will inevitably look for ways to benefit itself at the expense of your health.

In almost all cases, no matter how severe the injury, an insurance company will eventually turn to another doctor to provide an opinion on your post-injury medical condition or ability to perform work. This doctor performs what is called an Independent Medical Examination, or IME.

An Independent Medical Examination is a tool primarily purchased by an insurance company to make decisions on whether it will pay for medical or other types of benefits. The IME doctor will give an opinion on your condition that may contradict the opinion of your trusted family physician. The insurance company that payed for this opinion will use it to decide on whether or not they will pay for benefits. Most of the time, the IME doctor will give the insurer a way out from paying your medical bills or wage loss.

So how does this all work in practice?

Let’s say you were injured at work three months ago and you’ve received a letter in the mail from the insurance company asking you to attend an IME. You may ask yourself, “Do I really need to go?”

YES. You need to cooperate with the insurer to the best of your ability and make it to the exam. If you’re unable to attend at the time and date indicated on the letter, the exam provider will provide reasonable accommodations for your schedule. If you haven’t already contacted an attorney about your injury claim, this is an important time to do so. 

So now you’ve worked out all the details and you’re waiting in an exam room at the office of the IME doctor. What can you expect from the exam?

The first thing to understand is that the doctor that walks into the room does not represent your interests. They will not give you any recommendations or treatment. The doctor is only there to ask some questions about your current injury or possible prior injuries, and then perform a brief physical examination. That’s it. A full exam can take as little as ten minutes and will rarely last longer than thirty minutes. Some IME doctors will do multiple exams every day of the week. Most people who have attended an IME found the exam to be cold, impersonal, and off-putting.

A few weeks after the appointment, the IME doctor will provide the insurance company with a report outlining their opinions on your condition and ability to perform work. This report will likely disagree with the opinion of your treating physician. It is very possible that the insurance company will send you a letter stating that they will no longer pay for medical or wage loss benefits, or that they will stop paying in the near future.

Before, it seemed as though the insurance was working with you. They were on your side. They took care of your medical bills and paid you benefits so that you could take time off work for some much-needed recovery. But now, instead of relying on the opinion of your doctor, who knows you and has been caring for you since the beginning, the insurance company has paid for a second opinion from a doctor who probably barely examined you. 

If that seems self-serving and unfair to you, then you’re not alone. And when you’re reading the contradictory opinions of a doctor that met with you for 15 minutes for an exam that you took time from your job to attend, that’s the time when you need to start protecting yourself.

When you’re ready to take action to protect your interests and health, call Aaron Ferguson Law for a free consultation with an attorney. We’ll do our best to make sure the only doctor’s opinion that matters is the one that you trust to take care of you and your family.

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