Independent Medical Exmainations: Knowing Your Rights Under the Georgia Workers' Comp Act
Often, I am told by my clients that they do not agree with their doctor's opinion regarding their diagnosis, work restrictions, and treatment options. I am never surprised to hear this because with workers' compensation, you are usually only allowed to select a physician from a list of 6 doctors the employer and/or insurance company has pre-screened for their practice tendencies and willingness to cooperate with the attorney or nurse case manager who represents the interests of the employer or insurer. Furthermore, employees are often skeptical of doctors who are selected by their employer because they do not know the doctor's reputation or feel they have not been treated fairly.
With that being said, the overwhelming majority of doctors who are on panels will not be persuaded by the insurance company's attorney or nurse. There are good doctors on employer's panels. The majority of doctors will do the right thing, and give an honest assessment of the injured workers' symptoms, diagnosis, treatment options, and ability to return to work. Therefore, the decision to request an IME should be considered carefully.
When a client desires to have an independent medical examination or IME, certain requirements must be met under the Georgia Workers' Compensation Act for the insurance company to be financially responsible for a Claimant's one-time IME. O.C.G.A. Sec. 34-9-202 (e) (the applicable law) requires that the case has been accepted as compensable, meaning the employee has received money for their lost time from work, and the injured worker must have received a check within the last 120 days at the time of the appointment. So, if an injured employee's case has not been accepted as compensable, it is often very difficult to arrange for a second opinion; however, other options are available. (The employee can pay for an IME or the attorney can pay for it as part of the expenses of litigation.)
At the IME, the physician will perform a thorough physical examination of the injured worker, take a complete medical history of the injury, and review any x-rays, CT scans, or MRI's the worker has had. In many cases, the doctor will take his own x-rays to confirm the diagnosis. After the doctor has had an opportunity to examine the injured worker and review his or her records, the doctor will issue an opinion. The opinion will usually state whether he or she agrees with the patient's former treatment, diagnosis, work restrictions, and permanent partial disability rating, if applicable. Occasionally, the doctor will recommend further treatment and testing and state whether he or she is willing to take over treatment as the authorized treating physician.
The opinion is an invaluable tool in providing a non-biased and independent medical opinion as the name suggests. The opinion can be used as a basis for convincing the judge that a change in physician is necessary or help the injured worker obtain a better lump sum settlement than the one offered where the insurance company and employer want to settle, but do not want to pay for appropriate future medical treatment or a realistic permanent partial disability rating. Note, the employer and insurance company have to pay for this examination; however, they can require that the injured worker attend an employer's IME with a doctor they know will side with them.
Workers' compensation comes down to what your doctor thinks about your injury. Be sure to pursue an IME if you feel your current doctor is not treating you fairly or you want to try a different course of action. With a little patience and understanding, the workers' compensation laws can work in your favor. However, I always recommend you consult with a qualified and experienced workers' compensation attorney who devotes a large portion of his or her time exclusively to workers' compensation to get the best results.
