Independent Medical Examinations: What's It All About?

So what is an Independent Medical Examination (IME)? And why is it so important in Georgia workers' compensation claims? The answer is not simple, because 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 for the purpose of providing a second opinion. The IME doctor should make a diligent effort to address some of the issues the patient is having and try to figure out what is or is not going right medically speaking. He or she may also address the injured worker's current work restrictions, treatment options, the necessity of a recommended surgery, and when applicable, the injured worker's permanent partial disability rating if one has been issued.  

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 diagnostic tests are consistent with a serious injury (usually through x-rays, CT scans, EMG's, or MRI's), but the treating physician is skeptical of the employee's complaints of pain or the doctor's specialty does not focus specifically on the type of injury my client has sustained, I recommend an IME to confirm or dispute the treating physician's opinion on the case. Occasionally, the authorized treating physician will take offense to the IME. However, I make every effort to explain the purpose of the IME to the treating physician whenever possible. My job as an attorney is to zealously represent my client and in some cases that involves double-checking a doctor's findings with an equally qualified peer unassociated with the treating physician's practice or a specialist who works primarily on the type of injury sustained. 

Second, I will recommend an IME even where I know I have a good and reputable doctor treating my client, but my client is still doubtful of the diagnosis, treatment options, or work restrictions. In that case, I will recommend an IME for the sole purpose of addressing my client's concerns. As any doctor knows, peace of mind for a patient is a part of the healing process. Further, I feel as though what sets a good workers' comp. lawyer apart from a bad one, is a genuine and sincere interest in making sure all of my client's concerns are addressed and ensuring that my clients feel as though they were thoroughly examined and were given sound medical advice, especially if an injured worker is facing surgical intervention.

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 treating that particular condition is required for a diagnosis or treatment plan. This infuriates the insurance industry because of the cost associated with IME's involving very difficult atypical cases, but every workers' compensation lawyer should be willing to try to provide the very best care he or she can for their clients. Period!   

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 select an IME physician he or she believes will disagree with the employee's current restrictions, diagnosis, or the medical necessity of a procedure such as an expensive surgery. The overwhelming majority of doctors will not compromise their integrity and reputation to please a defense lawyer; however, the truth is litigation is a high stakes game, and a few bad apples will provide an opinion contrary to that of the authorized treating physician. 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 into litigation. In the first scenario, the defense attorney will argue at the mediation or in settlement discussions that the IME doctor's opinion is better and almost guarantees them a victory if the case were to go to trial. In the second scenario, the employer/insurer may be assessed the employee's attorney's fees if they have unreasonably denied or controverted the case, so an IME opinion stating their decision to controvert the case or deny surgery may be used to show that they were not unreasonable. Interestingly, over 75% of the time, the decision to controvert a case or deny a surgery comes before the Defense IME is even performed! (Talk about putting the cart before the horse.)

For more information on when an injured worker can use his or her an IME, see my corresponding blog post entitled "Independent Medical Exmainations: Knowing Your Rights Under the Georgia Workers' Comp Act" under the Archives section of this Blog.

If you have been ordered to undergo an IME by your employer or its insurance company and have any questions or concerns, please feel free to call our office for a free consultation.

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.