Why an Independent Medical Exam Could Affect How Long You Receive Workers’ Comp Benefits

As many know, the Pennsylvania Workers’ Compensation system is meant to provide wage loss and medical benefits for injured workers in the commonwealth who suffer work-related injuries. These benefits are meant to provide a sense of security to those who suffer work-related injuries while they recover. However, many workers are not familiar with the concept of an Independent Medical Exam (more commonly referred to as an “IME”). 

You may be surprised to learn that an IME can be used by insurance carriers to influence your entitlement to workers’ compensation benefits. It is often the most important part of an insurance carrier’s case against injured workers and can be used to either prevent an injured worker from receiving benefits or to stop or modify their workers’ compensation benefits. Therefore, if you suffer a work-related injury, it is of the utmost importance to understand why IMEs are requested, how they work, and how the results of the IME may impact your entitlement to benefits. 

What Is an Independent Medical Exam?

An independent medical examination, or an IME, is a legally required medical evaluation performed by a doctor chosen by the Employer’s Workers’ Compensation Insurance Carrier to evaluate an injured worker. IMEs are often used to get an opinion on the cause of the injury you sustained, whether there are pre-existing issues affecting your condition, whether an injury is disabling, whether an injury has improved, whether work restrictions are necessary, and whether further medical treatment is necessary.

While it may be called an independent medical examination, the results of the IME are typically very unfavorable to injured workers and serve as a tool for insurance carriers to limit, terminate, or reduce workers’ compensation benefits.

What Is Done at an Independent Medical Exam?

Since this is a medical evaluation set up by the insurance carrier, an IME is a medical appointment where a physician-patient relationship is created and no treatment is rendered. Instead, the IME doctor will perform a physical examination and question you about your symptoms and treatment. Specific questions will be asked, and special testing will be performed to challenge any reported limitations by the injured worker. As mentioned above, since this is an exam that is set up by the insurance carrier and solely used to obtain an opinion, it can feel rushed, incomplete, and dismissive. After the IME, the physician reviews medical records and diagnostic studies and then generates a report containing the IME doctor’s opinions.

When Is an Independent Medical Exam Conducted?

There are a number of situations in which an insurance carrier may request an independent medical examination. As a general rule of thumb, an insurance carrier can have an IME performed about every six months or after a new alleged work injury. This means that insurance carriers request IMEs when the insurance carrier is denying a claim and the injured worker initiates litigation to obtain benefits, as well as when an injured worker is already receiving benefits, so the IME can be used to initiate litigation on their end.

So, How Can an Independent Medical Exam Affect the Duration of Your Workers’ Compensation Benefits?

As mentioned above, IMEs are used for a number of reasons depending on the opinions of the IME physician. For instance, an IME could be used to say that you are fully recovered from a work injury and able to return to work. If the IME physician believes that you are fully recovered from a work-related injury, the insurance carrier can file a Petition to Terminate your Workers’ Compensation Benefits. While this petition does not stop your benefits immediately, it initiates litigation and puts your wage loss and medical benefits in jeopardy.

Another scenario could be if an IME physician finds that you are not fully recovered, but capable of some form of work, and provides suggested restrictions. If that happens, the Employer may offer you a job within those restrictions. If you do not return to work pursuant to that job offer, then the insurance carrier can file Suspension or Modification Petitions. A Suspension Petition is often used to stop your wage loss benefits for not returning to the job offered to you. A Modification Petition is often used to lessen your wage loss benefits to the amount you would receive if you were performing the restricted work that was offered. Again, neither of these immediately stops or modifies your benefits, but it puts your benefits at issue and initiates litigation. 

Most commonly, an IME is used to dispute liability for a denied claim. If the IME doctor finds that you did not suffer a work injury whatsoever and is found credible by the Judge, then you may not be entitled to any benefits.

How Can a Workers’ Compensation Attorney Help With the Independent Medical Exam Process?

A specialized and experienced workers’ compensation attorney can help prepare you for the exam and challenge the IME doctor’s opinions in the event they are unfavorable to the injured worker. The attorney will help gather supportive medical evidence and cross-examine the doctor to push back against their opinions.

If you have been injured at work or are scheduled for an IME, call the attorneys at Stern and Cohen. Our attorneys have a wealth of experience handling the IME process and challenging the opinions of IME physicians. Our attorneys are ready to step in and prevent your workers’ compensation benefits from being affected at a moment’s notice.

Ensure your rights are protected. Contact Stern & Cohen for a free consultation, and our experienced attorneys will walk you through your options and work to safeguard the benefits you deserve.