Workers’ Compensation and Insurance Medical Examinations

by Karl Voigt

Insurance medical examinations (IMEs) are a tool used by workers’ compensation carriers to control costs. Whether a claimant has been receiving benefits or is just attempting to obtain them, the carrier has a statutory right to send them for an examination with a doctor of its choice. These exams – if they turn out favorable to the insurer – can potentially end benefits or stop them before they even begin.

Section 314 of the Pennsylvania Workers’ Compensation Act allows an employer to request its employee to submit to a physical examination by a health-care provider at any time after an injury. The examiner is generally chosen and paid for by the employer. The doctor is also asked questions by the carrier regarding the necessity of medical treatment, the patient’s physical capacities, or whether a full recovery has been made. As a result, the doctor generates a report and, if it is used in litigation, the doctor will later testify by deposition against the injured worker.

Often examinations don’t take place at an actual doctor office; rather, they are at “IME farms”, companies that actually contract with insurance companies to perform dozens or even hundreds of IMEs a week. Then, these “farms” contract with doctors to perform the IMEs. You can only imagine that these doctors are selected by the “farms” because they give reliable answers that favor insurance companies. Rest assured that your attorney will be familiar with the reputation of the examining doctor. More importantly, judges are often very familiar with these doctors and their reputations. If a doctor performs far too many IMEs with curiously identical opinions, judges may be less inclined to find them credible. It is therefore sometimes actually a good thing for the injured worker if the carrier chooses to send him or her to a doctor who has a reputation as a “gun for hire”.

It’s always fun to cross-examine these IME doctors as to how many IMEs they perform a week and at what price, then how many times they testify by deposition as a result, and at what price. It’s not unusual at all to do the math and come up with more than half a million dollars a year just for doing exams for insurance companies.

The general rule is that carriers can get two IMEs a year.

Of course, if you fail to attend an IME, Section 314 goes so far as to allow the carrier to stop your benefits until you attend a rescheduled examination.

So, you’ve gotta show up at an office building and tell some doctor about the whole history of your injury – and before – and then be subject to yet another physical exam. There are of course general rules for attending an IME. First, you don’t have to bring any diagnostic studies or films despite what the notice might tell you. You are not required to be the insurance company’s servant. Let them do the work and get films if they want to review them. Second, you should be cooperative during the exam, but not volunteer too much information. Let the doctor ask you questions. If the doctor fails to ask vital questions, that can be used against him during cross-examination. Your attorney may want to discuss the physical portion of the examination more with you.

You should be reimbursed for your mileage if you drive to the examination.

Interestingly, Section 314(b) does give you the right to hire a doctor to attend the IME with you. Unfortunately, this is a cost that is not reimbursable to you by the carrier. It may be difficult to even find a doctor who would be willing to attend an IME as an observer.

When our clients attend an examination, they are given a brief form to complete after the exam, so we can begin to prepare for the doctor’s report. Naturally, when it becomes “your time”, we will be prepared and on your side.

 

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