Independent Medical Examinations: What's It All About?
So what is an Independent Medical Examination (IME) a.k.a a Second Opinion? And why is it so important in Georgia Workers' Compensation Claims? The answer is not simple, as the IME is utilized by the employee's attorney and the employer's attorney for very different reasons.
An IME is an opportunity to have a different doctor physically examine an injured worker and review their medical records and diagnostic tests. The doctor may or may not spend a great deal of time with the injured worker depending on who requested the IME. If it is a Claimant's (injured employee) IME, the doctor will often make a concerted effort to really address some of the issues the patient is having and try to figure out what is or is not going right medically speaking. If the employer or insurer have requested the IME, the employee should usually (not always) expect a short interview and a minimal physical exam as the doctor has usually (again not always) made up his mind prior to the examination, and is only performing the physical exam so that the injured worker's attorney can't stand up in court and say "Your Honor, this doctor has issued an opinion and he has never even seen my client!"
From my perspective, as an attorney who only represents injured workers, I use the IME in three situations. First, when I find a client's objective medical records are consistent with a serious injury (usually through x-rays, CT scans, or MRI's), the treating physician is skeptical of or disregards their subjective complaints of pain, and releases the injured worker to return to work full-duty, I recommend an IME to confirm or dispute the treating physician's opinion on the case.
Second, I will recommend an IME where I know I have a good and reputable doctor treating my client, but my client is still doubtful of the diagnosis or work restrictions. In that case, I will recommend an IME for the sole purpose of addressing my client's concerns. Making sure we do the right thing is always inclusive of helping address my clients' concerns ensuring that they feel as though they were thoroughly treated.
Third, I will recommend an IME when an injured worker has an unusual condition such as Complex Regional Pain Syndrome (formerly known as Reflex Sypmathetic Dystrophy), and an expert in that particular condition is required for a diagnosis or treatment plan.
From the perspective of an insurance defense attorney, the IME is also used for three reasons. First, the insurance defense attorney may be unhappy with what the authorized treating phycian has to say. In that case, the defense attorney will want to select a physician he or she knows will disagree with the employee's current restrictions or diagnosis. The opinion can then be used for the other two reasons: 1.) to attempt to posture the case for a lump sum settlement by having something to use as fodder at a mediation or 2.) to avoid being assessed the employee's attorney's fees if the case is going to litigation. (The employer/insurer may be assessed attorney's fees if they have unreasonable denied or controverted the case.)
For more information on when a claimant can use his or her an IME, see our post entitled "Independent Medical Exmainations: Knowing Your Rights Under the Georgia Workers' Comp Act"
