I Went to an Independent Medical Examination and No One Sent Me the Report

November 16, 2022
David F. Stern

If you have not had the opportunity to read our previous blog on Independent Medical Examinations (IME), it is a worthwhile read.  I wanted to take the opportunity to write/educate the readers on what it means when you have attended an IME at the insurance company’s request and no one has sent you the report.  Under normal circumstances, the physician that performed the IME will have the report prepared and mailed to the insurance adjuster within two weeks.  Occasionally, if additional records are requested for review, it could take slightly longer.  However, it would be extremely rare for the report not to be done within four to eight weeks.  So, what does it mean if a couple months have gone by and the report has not been sent?  In fairness, perhaps it is just an oversight.  I have certainly seen that and when I have bugged the adjuster for a copy, it has been sent.  However, far more often than not, an excessive delay in providing the report or perhaps a complete refusal to respond to requests for a copy means something more.  Usually “hiding” the report means it was not favorable to the insurance company.  The report does not benefit the insurance company and they do not want the injured worker to see it.

Why would an insurance company not want an injured worker to see an IME report that contains opinions that are favorable to that employee?

That is an excellent question.  When the case was initially accepted as compensable, a document called a “Temporary Notice of Compensation Payble” (TNCP), or “Notice of Compensation Payable” (NCP) was issued.  This document sets forth the injury that the insurance company is accepting responsibility for.  Typically, they will accept the most harmless injury they can.  For example, if you hurt your shoulder, it probably says “shoulder strain.”  If you injured your knee, it might say “knee contusion.”  Even if these diagnoses are not even supported by the medical records, the insurance company will attempt to acknowledge the most vanilla diagnosis they can.  They will try to avoid liability for internal derangement such as a torn rotator cuff, a torn meniscus, or a herniated disc.  However, when that IME report arrived, the physician they hired may have concluded that the injury is much more serious than the simple diagnosis they listed on the TNCP or NCP.  The insurance company does not want you to see the report because they realize you may hire counsel and have someone press this issue further.

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What We’ll Do At Stern & Cohen:

At Stern & Cohen, we are on to this scheme.  We will persistently follow up for IME reports.  We keep your file on a computer diary and will not forget about the whereabouts of the report.  We will ensure that this report ends up in our hands.  Once it does, if the IME physician admits more extensive injuries than what has already been admitted, we will file a Petition in Court to fix this.  I cannot tell you how important this is.  I have seen situations where an IME admits an injury and nothing was ever done.  Six months later, IME #2 with a different doctor comes up with a less severe diagnosis.  The insurance company then has a basis to contest your allegation that your injury contains the torn knee or shoulder, or herniated disc in your neck or back.  Had the Petition been filed after the first IME, they could not fight this.  Once we file the Petition, we find that the insurance company caves in immediately.  There becomes an agreement to enter into a “Stipulation” that corrects the injury that the Employer is responsible for.  There is commonly no fee for us to handle this aspect of your case.  We know how important it is to have the insurance company liable for the full extent of your injuries, not the minimal diagnosis they try to get away with at the beginning of the claim.  If you tore your knee, shoulder or wrist at work, do not let the insurance company get away with not acknowledging the full extent.  If you herniated a disc in your neck or lower back and now you have a nerve injury too, do not let them claim that it was just a strain – the insurance company should be on the hook for everything here.
If you have an upcoming IME or recently attended one, call us.  The consultation is free.  We should discuss what to expect at the IME and afterwards.  It is important to know your rights.