Independent Medical Examinations

What is an Independent Medical Examination?
Why did my employer schedule an Independent Medical Examination?
How frequently can the insurance company schedule such examinations?
Do I have to go?
How far can the insurance company send me to see one of its doctors?
Who pays for me to get to the examination?
Who pays for the examination?
Can I take someone with me?
Can that person come with me into the examination?
Will my lawyer or someone from my lawyers office attend?
Can I tape record the examination?
The letter scheduling the exam says I have to bring my films. I don’t have them. What should I do?
What should I do during the examination?
What should I do after the examination?
When will I know the results of the examination?

What is an Independent Medical Examination?

An Independent Medical Examination is far from “independent.” Your employer, or its insurance company is sending you to see a doctor that it has hired to obtain an opinion about your injury. Many doctors who perform such examinations for employers and insurance companies skew their opinions in favor of the insurance companies in order to continue to receive assignments. This kind of work can be very lucrative. The financial interest of the doctor can have an effect on his opinion. Other doctors are more fair. Doctors who do a lot of these examinations become familiar to the lawyers and judges. They develop a reputation with regard to their fairness.

Why did my employer schedule an Independent Medical Examination?

Your employer is hoping that the doctor will provide an opinion that will assist them in limiting your benefits. If the doctor concludes that you are fully recovered from your injury, the insurance company will file a petition to terminate your benefits. If the doctor concludes you are not fully recovered, he will be asked to comment upon you ability to work. If the doctor indicates you can work with certain restrictions, the insurance company will hire a vocational expert to establish what work is available within those restrictions. Then, the insurance company will file a petition to suspend or modify (reduce) your benefits. Sometimes, your employer will request an examination when there is a question about what medical care is appropriate for you (e.g. the need for surgery). Sometimes you employer will request and examination to determine whether it should accept a new workers’ compensation claim.

How frequently can the insurance company schedule such examinations?

Your employer is entitled to the first examination as a matter of right. Subsequent examinations may only be scheduled if the request is reasonable. As a general rule it is considered reasonable to obtain an examination every 6 months.

Do I have to go?

Yes. If it is the first request, you must go. If it is another examination, you will most likely have to go if it has been more than 6 months since your last examination. If you do not go, your employer can request an Order from a workers’ compensation judge directing you to attend. If you do not go after such an Order has been entered, your wage replacement benefits can be suspended until you attend.

How far can the insurance company send me to see one of its doctors?

That depends on the facts of your case. Generally, they can send you ass far as members of your community would go to seek medical care. If you have an injury that limits your ability to travel, you may be able to object to an examination that is too far away. Talk to your lawyer if you have a concern. Often concerns like these are addressed by the insurance company providing a car & a driver so you can sit or lie down during the journey.

Who pays for me to get to the examination?

Although the insurance company is not generally obligated to pay for your mileage to and from your treating doctors, it is liable to pay for your travel expenses to and from the IME. If you transport yourself to the IME, keep track of your miles (or use MapQuest to calculate them) and submit a request for reimbursement. If you prefer, arrangements can be made with the insurance company to hire a car to transport you to the IME. If you choose to be transported by a hired driver, remember the driver is not your friend. Do not talk to the driver about your injury, your claim, or your activities. Fell free to talk about the Phillies or the Eagles. Do not talk about yourself.

Who pays for the examination?

Your employer is responsible to pay the doctor and to reimburse you for your travel expenses. You should keep track of your mileage or any other travel expenses and submit a request to the adjustor for reimbursement.

Can I take someone with me?

Yes. If the insurance company is providing transportation, you should let them know you are bringing a friend or significant other.

Can that person come with me into the examination?

That depends on who you bring and the particular doctor. The law only requires the examining doctor to allow a nurse or doctor of your choice to sit in on the examination. Some doctors will allow friends, spouses or significant others to attend.

Will my lawyer or someone from my lawyers office attend?

No. Because the doctors are required to allow only a nurse or doctor to attend, they do not allow lawyers to attend the examination.

Can I tape record the examination?

If the examining doctor allows you to do so, you may record the examination. Because much of the examination is not a verbal exercise, recordings are of limited value. If you make a recording secretly, without asking the doctor for permission, you will commit a crime under Pennsylvania law. For that reason, surreptitious recordings of examinations are useless.

The letter scheduling the exam says I have to bring my films. I don’t have them. What should I do?

Nothing. It is the policy of Warren McGraw & Knowles LLC that our clients are not messengers for the employer or its insurance companies. We do not believe that it is your responsibility to run around and collect your films. We will provide the insurance company with an authorization signed by you so that they can obtain the films if they want them. We notify your employer or its insurance company of this policy in advance. If you have certain films, bring them with you, but do not go out of your way to collect them.

What should I do during the examination?

• Be prepared & BE HONEST
• Answer the doctors questions about your past medical history. If you have suffered previous injuries or conditions involving the same body parts tell the doctor about ALL of those injuries or conditions. If the doctor asks you a question that only pertains to one injury or condition, when you have suffered several, be sure to tell him about ALL your prior conditions even if he/she does not ask you the specific question. When it comes to your past medical history, make sure you volunteer ALL information about your prior injuries or conditions. If you are not sure whether a prior injury or condition is relevant, tell the doctor about it.
• When the doctor asks about how your injury occurred. Provide the doctor with a concise explanation that is consistent with your previous explanations to other people and other doctors. Answer the doctors questions about how your were injured, but don’t volunteer information beyond what the doctor asks. Don’t feel like you have to tell the doctor every detail.
• Give the doctor a complete list of the complaints that you have as a result of your injury. Start from the tip of your head and work down so that you do not forget anything.
• Don’t exaggerate your complaints. The doctor is looking for exaggeration and will discredit your complaints if you exaggerate.
• On the other hand, don’t minimize your complaints. The doctor can only check the issues he knows about.
• Cooperate with the doctor’s examination. Do not refuse to perform a maneuver or test unless that maneuver will cause you additional injury or harm.
• Understand that the doctor will perform similar tests in different ways, while trying to distract you with questions or instructions. He wants to know if the results of similar tests are the same when you are distracted and undistracted. If they are not the same , he will discredit the results of the test. If they are the same, he must accept the results. You will not be able to tell when the doctor is doing this. The point is that you should report only what you fee. You should not report what you think you should be feeling or what you have learned, through other doctors, is a significant response.

What should I do after the examination?

As soon as you can, after the examination, write down a summary of what occurred.

• Note the time that you arrived at the office.
• Note the time that you were called back into the examining room.
• If a nurse or other assistant obtained information from you, note the amount of time that was used to gather that information.
• Note the time that the doctor came into the room, the length of time you spent together, and the time he left.
• If the doctor is the one who gathered the information, try to note the duration of the questioning and the duration of the examination, separately.
• Note anything that you thought was unusual.
• Note anything that you thought was important.
• Summarize any conversation that you had with doctor about his conclusions or recommendations but expect that the doctor will not have such a discussion with you.
• Provide a copy of the summary to your lawyer.

When will I know the results of the examination?

After your examination, the doctor will prepare a report and send it to your employer or its insurance company. If your employer thinks that the doctor’s opinions will help them limit your benefits, they will take legal action. Once they have taken legal action, they will have the obligation to disclose the results of the exam. If the insurance company does not take any action based upon the examination, you will most likely not know the contents of the report until your case is involved in some type of legal action at a later time.

I generally do not recommend asking for a report if the insurance company does not take any action. Sometimes, reports that an insurance company might use to threaten your benefits get misfiled or buried because of the high volume of paperwork generated by the workers compensation system. If you ask for the report because you are curious, you might just be calling the adjustor’s attention to the fact that he/she should be using that report to threaten your benefits.