An Independent Medical Exam may be scheduled by the workers' compensation insurance company in your Pennsylvania claim. The IME is almost always intended as a big step by the insurer toward blocking or ending your right to beneftis under the Pennsylvania Workers Compensation Act. It is very important that you speak with a good work injury lawyer
before you attend an IME, or you are very likely to soon be very unhappy.
The Independent Medical Examiner is far from "independent." The doctor is hand-picked by the insurance adjuster or an attorney for the insurance company, and they have a plan. Doctors who perform such examinations are selected because they produce a predictable result favorable to the insurance company and because they are good at providing testimony
helpful to the insurer in stopping a claim for benefits, rather than good at providing treatment helpful to the injured claimant.
Often, insurance representatives such as adjusters and nurse case managers will try to make an injured worker believe the IME is merely for a "second opinion" or for a new doctor to weigh in to support the injured worker's need for a test or procedure. This is always a trap. It may be true that if
the IME doctor somehow approved the sought-after test or procedure the insurer would then likely fund it. But the adjuster who selects the IME doctor, and arranges to pay the doctor for an examination and a report, is fully expecting the IME doctor to provide a report that adopts exactly the position most favorable to the insurance company. A positive MRI will not save you. The legitimacy and severity of your work injury will not protect you. The purpose of the IME is simply to obtain a report from an insurance-oriented doctor who will give the adjuster cover for denying access to treatment or, very often, claiming that you have fully recovered from the work injury, or even that the work injury never really happened, that any prior doctors supporting the claim are wrong and that the injured worker is big fat fraudulent faker and a cry-baby who no one should ever listen to, ever again. Your positive MRI? The IME expert may be expected to say the findings are "degnerative" in nature, and do not count toward your work-related injury, limited to "strain and sprain". Company doctors supporting you? They were mislead by "non-anatomic" complaints or by an incomplete understanding of your past medical history or the degenerative nature of your pathology.
In the vast majority of cases, the IME doctor will be very strongly predisposed to offer the insurance company that hires him strong and compelling and very impressive-sounding arguments why your claim should be disputed, denied or ended. In fact, the more serious and well-documented your legitimate injury may be, the harder the adjuster may work to find an IME physician who will provide the opinions the insurance carrier needs to hurt you. Well-practiced IME doctors have ways of helping insurers, whatever the evidence.
This is not a "worst case scenario," but rather a situation that is repeated again and again in almost every case. Any competent and experienced Pennsylvania workers' compensation lawyer will tell you this is the absolute norm -- the standard outcome -- expected from an IME. This is what the IME is for.
The purpose of the IME is specifically to give the insurance company medical evidence to use against you, not
to in any way help you in your claim or advance your right to treatment. Shame on insurance adjusters and case managers who try to tell injured employees otherwise.
The insurer is nevertheless entitled to send you for IME examinations. The Act provides that two such insurance medical examinations per year are to be considered reasonable, though under some condions insurers are permitted more.
BUT YOUR WORK INJURY GIVES YOU RIGHTS!
Even though the point of an IME is for the insurer to stack the deck against you, there are ways to protect your rights. Call the experienced workers' compensation attorneys at The Law Offices of Timothy Kennedy, before
submitting to an IME, if at all possible. We can give you specific advice and point-for-point instructions on how to handle the Independent Medical Examinaiton, what other steps you should immediately take to protect yourself from the results of an IME, and how to respond if and when the insurance company tries to use the Independent Medical Examination results to block or stop your right to compensation. The sooner you call, the better able we will be to protect and advance your rights, and possibly to avoid a fight that will put your right to compensation at risk.
Call Tim Kennedy today at 484-453-8144