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What if the employer’s insurance company schedules an IME?

On Behalf of | Jun 16, 2020 | Workers' Compensation

When injured workers pursue workers’ compensation benefits, their employer’s insurance company may question the extent of their injuries. In these cases, insurance companies often arrange an independent medical evaluation (IME).

This is a common issue that injured workers come across. Therefore, here is some essential information they should know about an IME, so they can protect their rights to collect the workers’ compensation they deserve.

What is an IME?

An IME is a medical evaluation not performed for the purposes of medical care or treatment. The primary purpose of the evaluation is to generate a report for the requesting party, the Employer and its Insurer. During the IME, the doctor will:

  • Assess the claimed injuries;
  • Evaluate whether these injuries are related to the work accident; and
  • Determine if the treatment either being received or recommended is medically necessary.

It is important to note that the doctors receiving such referrals from insurance carriers often work very closely with the same insurance company or their representing attorney. Even though an insurance company may claim that the IME is a “second opinion,” such an evaluation is often used support an insurance carrier’s position to deny medical treatment or reduce compensation for permanent injuries.

Although injured workers may not desire to attend an IME, the Maryland Workers’ Compensation Act generally requires attendance; otherwise, an insurance carrier will have a right to suspend benefits (Maryland Code, Labor & Employment §9-720).

How can workers prepare for an IME?

If workers must attend an IME, they should speak with an experienced workers’ compensation attorney beforehand. That way, they can understand their rights as well as how they can protect them during the IME.

Insurance carriers will often require non-represented injured workers to provide medical documentation of their injuries. However, this is not required, and it is of benefit to have an attorney who can gather such information on behalf of the injured worker. Furthermore, once the evaluation is completed, the IME physician will not provide a summary of his or her opinion to the injured worker. Instead, a report with the doctor’s medical analysis and opinion will be provided to the insurance carrier’s review.

All in all, an IME is often a very significant appointment following a work-place accident. Preparing and participating in the evaluation may be confusing and daunting, and the ultimate opinion may be difficult to understand for a non-medical professional and, quite frankly, detrimental to a Claim. As a result, it is critical for injured workers to seek an experienced attorney to assist in such a potential turning point in a Claim.

  • AABA