If you have sustained a work-related injury and are pursuing a claim, you may wonder, “What is an IME in workers’ compensation cases?” An Independent Medical Examination, or IME, is an examination you undergo at your employer’s request. Your employer and its insurance carrier use the examination to assess the nature and extent of your injury. This helps determine the amount of compensation you may need. The outcome of an IME can greatly affect your workers’ comp case.
What Happens in a Workers’ Comp Investigation?
Employers and workers’ compensation insurers hire investigators to scrutinize the validity of the claims made by injured employees. When conducting a workers’ compensation investigation, the investigators may:
- Interview witnesses to the workplace accident
- Analyze any video surveillance footage
- Check an injured worker’s social media postings
- Put covert surveillance on the injured worker
- Ask neighbors, friends, and family members about an injured worker’s activities and disability level
- Review records to find out when the workplace injury occurred and whether the claim complies with the state’s rules
An employer may also request an injured employee to submit himself or herself for an Independent Medical Examination. The employer and insurer may dispute or deny an injured employee’s claim if they obtain evidence of employee misconduct, intoxication, or an injury not being severe or work-related.
What Is an Independent Medical Examination (IME) in a Workers’ Comp Case?
Receiving an IME request will leave you asking yourself, “What is an IME in workers’ comp cases?” The Illinois Workers’ Compensation Act allows your employer to send you for an IME. Several circumstances may lead your employer to send you for an IME. The employer’s insurance company may not agree with your personal doctor’s opinion, your workers’ compensation claim could be getting expensive or taking too long to process, or the company may want more evidence to settle a dispute regarding your claim.
The doctor that the employer or its insurance company chooses to conduct the IME may be located in Chicago or elsewhere, including outside Illinois. According to Illinois workers’ compensation law, your employer will be responsible for travel costs, missed wages, and other costs you incur to travel to the examination’s location. The prevailing reimbursement rate in 2022 in Illinois is 62.5 cents per mile. Failing to attend an IME may result in the temporary suspension of your workers’ compensation benefits.
What to Expect at an IME
An IME involves both a physical examination and questions from the examining doctor. The doctor may conduct several tests to evaluate your reflexes, range of motion, sensitivity, and pain tolerance. Your IME doctor will review your prior medical records. He or she will also ask questions about your workplace accident and injury.
You won’t receive any medical treatment during the IME. IME doctors usually look for signs of deception, such as lying or exaggerating symptoms and pain, during physical exams or as the workers’ compensation claimants answer questions.
What Happens After an IME?
After the examination, the doctor will compose a written report containing his or her findings and recommendations. He or she may issue the report to you and your employer or provide testimony regarding his or her opinion at your workers’ compensation hearing. If there will be a hearing for your case, then the report should be delivered no later than 48 hours prior to the time set for the hearing.
In some situations, the IME doctor may oppose your treating doctor’s opinion. For example, your doctor may say you need surgery, but the IME physician may contradict that. The IME doctor may also assert that your injury isn’t related to your work, or you aren’t hurt. These findings may give your employer or insurance company grounds to deny a proposed course of treatment or your claim. Instead of allowing the IME report to stand, you should contact a workers’ compensation attorney to help you fight back.
The attorney will help you prove that your treating doctor’s opinions are more credible and show the IME report to be biased and inaccurate. The sooner you involve an attorney, the better the chances of successfully challenging and discrediting the IME physician. In fact, the best way to avoid getting a bad IME report is to get a good attorney before attending an IME.
How Can an Attorney Help Me Prepare for an Independent Medical Evaluation?
Employers commonly use IMEs as a tool to withdraw authorizations and suspend workers’ compensation benefits. How the examination unfolds can have a considerable impact on your claim. For example, anything you say, such as saying you are fine when the doctor introduces himself or herself and asks how you feel, can be used against you. Lying or saying something that can make the doctor think you are exaggerating will also hurt your case.
IME doctors are hired by workers’ compensation insurance companies. They are not on the side of the injured employees. Your IME doctor is likely to be motivated to look for contradictory information or some other problem with your medical treatment or case on behalf of the insurance company that hired him or her. Therefore, volunteering information that the doctor hasn’t requested could affect your case negatively.
When you receive an IME request and contact a workers’ compensation lawyer, the lawyer will walk you through the examination process. Your attorney will instruct you on communicating effectively and responding appropriately to the IME doctor. The doctor may ask about your medical history, so it will be important to have a clear timeline in your mind. Your attorney will help you familiarize yourself with it and present the medical records that will be the most informative to the doctor. An experienced workers’ comp attorney may even be familiar with the doctor in your case and will give you additional advice suited to the physician to whom you have been sent or other factors specific to your situation.
Legal fees may stop some injured employees from seeking the assistance of a lawyer. However, there’s no risk in seeking the help of a lawyer in Illinois because the lawyer handling your case can only be paid if he or she helps you recover more money than what your employer was offering to you prior to representation by the lawyer. Several other limits also exist for how much a workers’ comp lawyer costs in Illinois.