Medical Examinations for Workers' Compensation

Wisconsin Workers’ Compensation Laws Define Your Rights Regarding Independent Medical Exams (IMEs)

Rules for Independent Medical Exams

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.

“Reasonable” Examinations

Wisconsin workers’ compensation law allows the insurance carrier to request reasonable examinations. The term “reasonable” has been interpreted to mean no more frequenty than once 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 absent compelling circumstances.

Limits on Second Opinions

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 them if dissatisfied with the 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.

Notice of Exam

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.

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.

Avoid Exam Obstruction

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.

IME Report

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.

Contact a Wisconsin Workers’ Compensation Attorney

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. Please call a Madison workers’ compensation attorney directly at (608) 257-0040 or a Milwaukee workers’ compensation attorney at (414) 271-8650, or email us via our Contact Page.

Rules for Independent Medical Exams

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.

“Reasonable” Examinations

Wisconsin workers’ compensation law allows the insurance carrier to request reasonable examinations. The term “reasonable” has been interpreted to mean no more frequenty than once 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 absent compelling circumstances.

Limits on Second Opinions

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 them if dissatisfied with the 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.

Notice of Exam

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.

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.

Avoid Exam Obstruction

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.

IME Report

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.

Contact a Wisconsin Workers’ Compensation Attorney

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. Please call a Madison workers’ compensation attorney directly at (608) 257-0040 or a Milwaukee workers’ compensation attorney at (414) 271-8650, or email us via our Contact Page.

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