Medical Examinations for Workers CompensationWorkers Compensation Laws Define Your Rights Regarding Independent Medical Exams (IMEs)
The most common tool used by workers compensation insurance carriers to deny claims is the so-called Independent Medical Examination (IME). The insurance carrier will ask an injured worker to submit to an examination by a physician of its choosing when it wants to refuse the claim entirely, or it wants to stop paying the claim after initially agreeing to pay benefits.
Wisconsin workers compensation law allows the insurance carrier to request reasonable examinations. The term “reasonable” has been interpreted to mean no more frequent than one every six months. This means if an insurance carrier sends you to an IME doctor, it cannot send you back to the doctor for another six months.
The insurance carrier is also generally not allowed to change examiners after one has already examined you. That rule prevents carriers from obtaining an opinion more favorable to it if dissatisfied with its first examiner’s opinion. There are two situations, however, where the insurance carrier is allowed to change examiners. The first is when the original examiner is no longer available (i.e. death, retirement, relocation) to perform another exam. The second is when the work injury causes two or more conditions whereby different specialties are needed to provide opinions, like a fall resulting in both a head and back condition.
The insurance carrier is required to give written notice of the examination. It must give the date, time, and address of the examination. It must also indicate the specialty of the examining physician, provide instructions on how to make arrangements for another date if there is a scheduling conflict, and inform you that you may bring your treating physician at your own expense. Finally, the carrier must pay travel expenses in advance and reimburse you for any lost wages incurred due to the examination.
Who May Attend the Examination?
As noted above, you may bring a treating physician along with you to an IME. The law is silent on whether or not you are allowed to bring family members or friends. Most IME doctors do not allow anyone other than you in the examining room.
The injured worker has no say in deciding whether to attend an independent medical examination. Simply refusing to go will likely result in the suspension of benefits until such time as you make yourself available for an examination.
The law requires the insurance carrier to provide you a copy of any independent medical examination report immediately upon its receipt. The carrier is not allowed to sit on the report, or ask for clarification from the examiner, before sending the original report to you.
If you have been asked to attend an independent medical examination, please contact a workers compensation attorney at Hawks Quindel to make sure the insurance carrier is complying with the law.