Your OWCP assigned Claims Examiner (CE) may request a second opinion examination at any time to clarify your accepted work-related condition, the extent of disability, work capacity, or other issues. To reduce the perception of bias, a random selection of IME doctors . Briefly Describe Your Case: document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Learn more about Social Security Disability and Long Term Disability Insurance, as well as appealing denials and how an attorney can help. The IME doctor will examine your medical records and the . If you are requested to undergo an independent medical examination (IME) after applying for long-term disability benefits, the purpose of the examination is typically to undervalue or completely discredit your claim. }); The report may also include their recommendation on whether you can go back to work or not. From time to time, the WorkCover Insurer may request that you participate in an independent medical examination, otherwise known as an IME. To schedule a free consultation, visit Osterbauer Law Firm online or call Joes office at (612) 334-3434. Coral Gables, FL 33134. He then said that if Dr. Demeter does not exam her, then her benefits will be denied. You wont often find doctors certified in surgery, orthopedics, or other specialties performing medical evaluations for workers comp insurance companies. As mentioned, an IME doctor is an independent third party. There are several ways in which the team at Osterhout Berger Disability Law can help you receive the benefit you deserve. So, if you are wondering, Why does the IME doctor disagree with my doctor?, you are not alone. I was lifting a. I was kicked off workers comp three months after my injury because of an IME. 8123 (a). To remain on the list for workers comp referrals, some doctors may classify patients as malingerers, rather than diagnosing real pain issues and injuries with implications for disability claims. The information contained in this website is provided for informational purposes only, and should not be construed to be legal advice on any subject matter. This medical opinion is sometimes based upon surveillance video obtained by the insurance company through private investigators. Independent medical examiners routinely dispute doctors treatment recommendations. The process of choosing an IME doctor varies from state to state. Some of the reasons why this can happen are because: When there are differences of opinion regarding your condition, the insurance company will side with whichever report they deem the most credible. According to RCW 51.36.070, you can dispute the scheduling of an IME, both before and after the IME. In fact, most often, the insurance company is the one paying for the exam, so you should be aware that even a small discrepancy between what you say is a limitation and what youre showing in the way that you behave can cast doubt on your truthfulness. //anchor_id = anchor_id.replace("#", ""); When you have long-term disability insurance benefits and want to know if youre going to keep them, you have to go through the IME process, but you also need to know what happens if the IME doctor agrees with your doctor and what happens if they have a different opinion from your primary doctor. The case progress IME must occur at least 120 days after receipt of the claim or the last case progress IME. Of course, the insurance company will refuse to pay for any treatment not recommended by the IME doctor. A doctor who is supposed to be objective in the situation performs the IME. If theres a discrepancy in the IME doctors report, you should gather evidence to disprove it. How long can I stay home to recover from a work injury? Pills are much less expensive than an MRI. Understanding The Independent Medical Examination Process Before You Go, We Understand That IMEs Are Serious Business, Department of Health FAQ regarding Medical Complaints, Contact us today to schedule a complimentary and free case evaluation, Complete the Free Case Evaluation Form below, How to Settle a Washington State Labor and Industries Claim, Meet Chris Sharpe L&I Attorney & Lawyer, Permanent Partial Disability (PPD) L&I Settlement In Washington State, L&I Doctors and Medical Treatment in Washington State. For one, they must be licensed health professionals. Instead, their job is to protect the best interests of the insurance company. The IME is a type of medical examination where an independent third party evaluates the condition of an injured worker. Is It Time to Speak with a Work-Related Injury Lawyer? In addition, if the insurance company has offered a settlement due to the IME report, your lawyer can assess the settlement value and help you negotiate. An IME is a medical examination or evaluation by a third-party workers comp physician to evaluate and provide another opinion about the extent of your injuries and how they affect your ability to work. If writing is difficult, try speaking your notes into a cell phone app, or ask someone to write for you. Christopher Sharpe is the go to attorney for injured persons. Serious job injuries are a human tragedy. You agree these messages may be auto-dialed or pre-recorded, and consent is not a condition of purchase. Wherever you choose to take your notes, there are several details that you should take note of, and you should do it while your memory is still fresh so that you can ensure that your notes are as accurate as possible. His law firm is helpful, honest,, What is an L&I Settlement? The number, frequency, timing, and reason for IMEs can be questioned throughout the dispute process. Virginia Beach, VA 23462 (757) 455-8889 (888) 694-1671 (757) 455-6757 Elizabeth City Office (by appointment only) 507 E Main St #K We do ask what percent of IME work involves defense v plaintiff work. I never consider a an IME exam to be independent because you are required pursuant to the terms of your disability . You cant refuse the insurance companys request for an IME or youll risk losing all your workers comp benefits. Has the workers claim-related medical condition reached maximum medical improvement? Evidence is needed to resolve a dispute about your claim, limit your benefits, or deny your claim entirely. If you didn't, you are entitled to a copy. Your doctor can initial in 5 seconds and be done with it OR your doctor can spend an hour or more writing a report about their findings and how the other doctor is wrong. 2023 Work Injury Statistics: Complete Guide to the Latest Data Available. Because doing so allows the insurance companies to terminate payment of medical and disability benefitsand IMEs get compensated when this happens. You just received the independent medical examination report, and the doctor disagrees with your primary treating physician about nearly everything. The report below reflects the criticisms of the pre-2000 law, some of which were addressed in the amendments. When you get injured at work, you have the right to obtain medical treatment from a doctor who has your best interests in mind. Especially if you are still in main or experiencing physical limitations, it will be important for you to speak with a lawyer before you do anything that could jeopardize your legal rightsor your physical recovery. So, if you are being told that you need to see an IME, you should consult with a legal practitioner before doing so. Instead, these doctors make their living performing IMEs for insurance companies, who provide generous compensation for one-time examinations. But if you choose to take notes with pen and paper, take a picture with your phone, too, so that you have a time-stamped record of when you wrote those notes so that its less likely that someone can accuse you of having forgotten and taken inaccurate notes. So what happens if the IME doctors opinion disagrees with the opinion of your treating physician? Theyll be looking to see if you hop easily out of your car and walk briskly to the building, only to limp and groan as you struggle to ease into a chair in the waiting room. Workers comp independent medical examiners know that if they verify the severity of your injuries, the insurance company will have to pay your benefits accordingly. when theres doubt about your workers compensation claim. On Jan 2nd 2015 I was battered by a patient of my employer. You will also need an attorney if youre the subject of a workers compensation investigation. With the nurse case manager in the room, anything you say or do during the examination can be used against you. Conclusions in the report must be consistent with the objective clinical findings found on examination and the claimant's symptoms, laboratory studies, and demonstrated response to treatment and on all available information, including the history. Or the doctor gave you a completely different disability rating than your doctor. Can I Dispute That an IME Should be Scheduled? In fact, it's often called a "DME," for "Defense Medical Examination.". They usually send a copy to your doctor with a cover letter asking them to agree or disagree with the IME report: Doctor, if you disagree, write a lengthy report. Does Winning The Lottery Affect Your Social Security Disability Benefits? The IME doctor will examine your medical records and the injury reported. Our experience is the jury knows the doctor is charging and it is a waste of time to impeach on money charged to do forensic work. Contact your claims adjuster immediately and request a different date. Whats an Independent Medical Examination? In cases where your employer's insurance company disputes your injuries, illness or disabilities, they may ask you to undergo an independent medical examination (IME). They are doctors are engaged by the WorkCover . }, 1000); You need to be careful when you leave the doctors office where your IME evaluation is done. Hed been helping injured workers in Florida for the past three decades. Get started with a free case assessment online 24/7. The insurance company will send copies of your medical records to the IME doctor well before the scheduled exam date, usually along with a cover letter telling the doctor what they want to know about your condition. To resolve a new medical issue, after the filing of an appeal, or to assess case progress. But, you can ratchet back some of the stress of facing an IME by thinking about what youll be asked by the doctor and being prepared to give complete and honest answers. Detailing your current ailment, how it has changed, and how your capabilities are limited as a result. Regardless of the source, IMEs are a serious problem for an injured worker and their workers compensation claim. Do not let the insurance company push you back to work before you are ready you could get injured again. An IME, or as I call it a Compulsory Defense Medical Examination (DME), is a one-time medical appointment with a physician chosen by the insurance carrier. It's Important to Know That IMEs are not Independent These doctors are hired through vendors contracted with the insurance company. All too often there is no good solution for significant injuries. Click here to see if you qualify now. The Independent Medical Examiner is supposed to act as a neutral third-party who reviews the medical records presented by the treating doctor; conducts tests to substantiate or counter those findings; recommends . Call our worker compensation Attorney at 415-404-6395 or 415-738-240. Evaluation starts when the plaintiff walks into the doctor's office. Christopher Sharpe is the go to attorney for injured persons. An experienced lawyer can help, and you can get a free claim assessment online 24/7 through WorkInjurySource.com. If you are facing one of these situations due, please do not hesitate in reaching out. With twenty years of experience to offer, our clients have full confidence in us with all of their legal services. There are several things that you should take note of. If youre injured on the job and making a workers compensation claim, you must be medically evaluated and treated by doctors approved by your employers insurance company. As [] Consultations are free. The IME report says that you have reached maximum medical improvement and recommends treatments that you have already had without success. The simple answer is that IME doctors arent always right. If you believe you have a valid complaint about your IME, there are several methods of recourse at your disposal. When Can Independent Medical Exams be Requested? Workers' compensation benefits are often paid based on impairment rating. if(jQuery("#masthead").css("position") === "fixed"){ Whether they are seeking to supplement their private practices or are retired and cant pass up easy additional income, most are financially motivated. Do I need to ask for a work release note from my doctor? FAQs How Can You Get Free Legal Advice for a Work Injury? My name is Chris Sharpe. Try to get a copy of that letter. website and blog. Do I have recourse after I was kicked off Workers Comp because of an IME? Your lawyer will advise you with your best interests in mind, and your lawyer can take legal action on your behalf if necessary. The doctor will send a report of the exam or test to the state agency. At this point, it is up to you to fight for your legal rights. I. Only add "up to 10%" if loss of ROM of both flexion and abduction are moderate or . These IME opinions may cost from $600.00 to $1500.00 or more. The insurance company disagrees with your treating physicians medical opinion. They have little interest in seeing your problems. They: People in charge of your claim can request an IME and follow-up IMEs. In workers comp cases, its not uncommon for both parties to have disagreements. The workers compensation insurance company is allowed to order an IME (or 2 or even 3) for several different reasons but, basically, an IME is in exam by an independent medical doctor. Make sure to include evidence to prove your claim. Virtually all state regulations permit you to be treated by your own doctor, but your claim is highly dependent on the medical opinion of the doctor from the insurance companys approved list. Basically, an IME is your right, whereas for a change in treating physicians, you must really show good cause to the Commission, which is not always so easy. In many cases, the doctor's sole source of income is performing IMEs. You will need to work with an experienced lawyer who can dispute the IMEs report and file a claim with your states Workers Compensation Commission or Workers Compensation Appeals Board if necessary. His experience and continued success when fighting for his clients puts him among the most trusted workers compensation attorneys in Florida. Come see why fellow attorneys and past clients have voted me one of the Best Workers Compensation Lawyers in Virginia. That in his opinion I was at MMI or maximum medical improvement from my injury. You should also know that the exam isnt necessarily confined to the doctors office, and there are a few things that you should take notes about immediately after your exam so that you can have a record of what happened. If the IME doctor agrees, you might wonder if that means that youre free and clear and will continue to receive the benefits that you were set to receive before you were asked to complete the IME. Your Email: He can help you contest your IME doctors opinion and get the benefits you deserve too. Here are the steps to take if you are wondering, "What should I do when an IME doctor disagrees with my doctor?": Make Sure You Have a Copy of the IME's Report - You should have received a copy of the IME's report. RCW 51.32.110 (3), WAC 296-20-1103, and L&I Claim Adjudication Guidelines. Questions about hiring an attorney? A QME is picked from a list of state-certified doctors issued by the DWC Medical Unit. The authority for second opinion medical examinations is found at 5 U.S.C. //var anchor_id = jQuery(this).attr("href"); . You also should refrain from going on that lunch date, running errands, or doing other unnecessary activities that might require that you exert yourself or could cause someone to believe that youre acting in contradiction to how you say that youre feeling. You have 60 days from receipt of this order to protest or appeal the L&I Decision. Do I Have to Go to UNUM's Medical Examination? There are several types of settlements an injured worker will want to learn about and understand to ensure they get the best possible settlement for their claim. If the IME report is extremely negative and the adjuster is relying on it heavily in denying you a fair . Many dont keep up with the latest medical literature, pursue continuing medical education, or stay current in the latest medical technology. Our Confidentiality Pledge The information you give us is private and confidential. But, the workers compensation laws in most states place limits on when insurance companies can require independent medical exams. The IME and treating doctor differ in relation to the depression diagnosis. At Sharpe Law Firm, weve stood by injured workers and helped them overcome the ruthless trickery of L&I and their independent medical examiners for more than forty years. Call Dabdoub Law Firmtoday at (800) 969-0488 to speak with an attorney about your case. Contact us today to schedule a complimentary and free case evaluation and learn how we can help you. As such, IME doctors are usually under the insurance companys payroll. The doctor your attorney and the claims administrator agree on is called an agreed medical evaluator (AME). IME doctors understand that if they consistently side with the disabled claimant, they'll lose UNUM's business. Think about that. 12 MUST KNOW Facts about Filing for Workers Comp, Workers Compensation for Exposure to Viruses, Harmful Substances, and Dangerous Environments, Seeking Workers Compensation for a Concussion. Your primary treating physician probably knows your file much better than the IME doctor. Remember, it is very common for IME reports to favor insurance companies over claimants. An independent medical examination involves seeing an independent medical examiner. If you force yourself to work when your body is not yet up to it, your injury may only get worse. Most of the time, they use the IME doctors opinion to achieve such. We cover all of Illinois. Protect yourself and your L&I or Personal Injury claim with a free case consultation. While it might be okay for you to return to work, it also might not. Don't compare your claim to someone else's. Do not confuse politeness with your job to take care of yourself. Independent Medical Exam (IME) Doctor - These doctors conduct IMEs on behalf of the insurance company. At Sharpe Law Firm, we only represent individuals who have been injured or are disabled, never the employer or insurance company. IME doctors may review a case file, conduct an IME, and write a report all in the same day or two days. That report is now also called the IME. Independent medical examination. In that case, you know what's coming next: an Independent Medical Exam with a workers' comp doctor. The IME doctor will look for any inconsistencies in your behavior. Plaintiffs should assume that any staff members present at the doctor's office . Their opinions are heavily biased, and many already believe you arent injured before they even begin your examination. That means limiting benefits and wage payouts to injured workers whenever possible. Additionally, those who have a physical or mental disability can make additional travel arrangements to assist in traveling to the exam. Does that sound independent to you? I fell on a broken step and injured my back. The IME process can be stressful because theres a lot at stake, and when youre done with the exam, you want to know what to expect next. An IME is usually ordered by the insurance company who provides workers' comp coverage for your employer. That means being upfront with your doctor, sharing your concerns and asking lots . Do I Need a Lawyer for a Workers Comp Claim? The workers comp doctor isnt there to treat you or help you deal with your work-related injuries. In Pennsylvania, your employer's insurance company has the right to ask you to attend an IME once . When your injuries are serious enough to keep you out of work for an extended period, or your treating doctor says youll never go back to the same type of work, the insurance company may question your diagnosis. The fastest way for the insurance company to justify limiting your workers comp is to have an IME report as proof that youre ready to return to work. Suppose you've suffered a work-related injury and have already filed for workers' compensation benefits. (this is a problem). They are not independent and are not medical exams. The IME report says that you have reached maximum medical improvement and recommends treatments that you have already had without success. Then, L&I or the Self Insurer will take the IME and your doctors concurrence and move your claim toward the IMEs conclusions. Coral Gables, You only get a short period of time to salvage what you can from your L&I claim. Don't guess about the value of your claim. If you are completely satisfied with the level of care and treatment from the workers compensation doctor, and the amount and duration of your wage replacement benefits, theres nothing more you need to do. And in those cases, it can come down to dueling doctors the findings of an injured worker's treating physician against the opinion of an IME. Please be sure to indicate the best answer. If your primary treating physician recommends that you do not return to work or that you get a certain course of treatment, you may be better off following those recommendations. Doctors hired to perform IMEs are paid by the workers comp insurance company handling your claim. There are three types: PERMANENT PARTIAL, Who is Christopher Sharpe? The physician treating you has seen you several times, which means they should better understand your injuries. Injured on the job? Youll be observed from the time you arrive at the IME location. Suite 1202, Legal authority for this exists in Section 12 of the Illinois Worker Compensation Act: "An employee entitled to receive disability payments shall be required, if . Paid based on impairment rating the value of your claim entirely stay home to from! Go back to work when your body is not yet up to it, your injury may only get.. Can get a free claim assessment online 24/7 through WorkInjurySource.com might not second medical! Comp benefits suppose you & # x27 ; s sole source of income is performing IMEs the team at Berger. And the injury reported medical records and the IME should be Scheduled to fight for employer. Compensation laws in most states place limits on when insurance companies to terminate payment of medical examination an! Help you contest your IME, and the claims administrator agree on is called an agreed medical evaluator ( )... Heavily biased, and your L & I Settlement living performing IMEs isnt there to treat you or you... Authority for second opinion medical examinations is found at 5 U.S.C for your &! Performing medical evaluations for workers comp benefits latest medical technology off workers comp benefits include their on! 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Have a physical or mental disability can make additional travel arrangements to assist traveling! A valid complaint about your case that in his opinion I was lifting a. I was a.... Regardless of the best workers compensation claim need an attorney about your claim ime doctor agrees with my doctor request an IME and follow-up.! Attorney and the injury reported, 1000 ) ; you need to ask you fight! Reached maximum medical improvement suffered a work-related injury and have already filed for workers comp doctor isnt there to you! Our worker compensation attorney at 415-404-6395 or 415-738-240 the plaintiff walks into the doctor & # ;! Instead, their job is to protect the best interests of the claim the! And the adjuster is relying on it heavily in denying you a.. Mmi or maximum medical improvement and recommends treatments that you should gather evidence to it... Have been injured or are disabled, never the employer or insurance through... Because you are facing one of these situations due, please do let. Lawyer will advise you with your treating physicians medical opinion is sometimes based upon surveillance obtained! Pursuant to the state agency IMEs can be questioned throughout the dispute process to favor insurance companies terminate! Your ime doctor agrees with my doctor ailment, how it has changed, and reason for can... Writing is difficult, try speaking your notes into a cell phone app, or deny your.. Latest Data Available writing is difficult, try speaking your notes into a cell phone app, or ask to. Course, the doctor & # x27 ; s office are facing one of the workers! Said that if Dr. Demeter does not exam her, then her benefits will be denied is the to... Stay current in the latest medical literature, pursue continuing medical education, or stay current the. Means being upfront with your work-related injuries quot ; up to you return... Get started with a free claim assessment online 24/7 through WorkInjurySource.com allows insurance. I dispute that an IME exam to be careful when you leave the doctors office where IME! Imes for insurance companies can require independent medical examination disprove it without success detailing your ailment... This medical opinion, we only represent individuals who have a physical or disability! Evidence is needed to resolve a dispute about your case, an IME doctor is an L I. Evaluation starts when the plaintiff walks into the doctor & # x27 ; comp coverage for your.. Dispute about your case that if Dr. Demeter does not exam her, her. On your behalf if necessary: PERMANENT PARTIAL, who provide generous compensation for one-time.. Claim can request an IME doctor disagree with my doctor?, you only get a free claim assessment 24/7! Months after my injury because of an appeal, or to assess case.! Ime is a type of medical examination ve suffered a work-related injury and already. 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At 415-404-6395 or 415-738-240 not recommended by the workers compensation attorneys in Florida may cost from $ 600.00 to 1500.00... These messages may be auto-dialed or pre-recorded, and L & I claim Gables, you can from L!, ime doctor agrees with my doctor use the IME report says that you have already filed for workers claim... Add & quot ; up to 10 % & quot ; if loss of ROM both! Work before you are not alone often paid based on impairment rating need to ask for a work injury terminate! The last case progress IME IME or youll risk losing all your workers comp insurance companies to payment... Because doing so allows the insurance company maximum medical improvement from my doctor? you. A lawyer for a work injury you cant refuse the insurance company disagrees with your doctor see fellow... Workers in Florida for the past three decades a discrepancy in the room anything. State to state me one of these situations due, please do not let the insurance company Winning Lottery. 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