Why an Independent Medical Exam Could Affect How Long You Receive Workers’ Comp Benefits
An Independent Medical Exam (IME) can significantly affect how long you receive Pennsylvania workers’ compensation benefits. Insurance companies often use IMEs to try to reduce, suspend, or terminate wage loss and medical benefits by arguing that an injured worker has recovered or can return to work.
What Is an Independent Medical Exam?
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 intended to provide a sense of security while an injured worker recovers. However, many workers are not familiar with the concept of an Independent Medical Exam, more commonly referred to as an IME.
An Independent Medical Examination 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 obtain opinions regarding the cause of an injury, whether there are pre-existing issues affecting a 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 often serve as a tool for insurance carriers to limit, terminate, or reduce workers’ compensation benefits.
What Happens During an Independent Medical Exam?
Since this is a medical evaluation arranged by the insurance carrier, an IME is not a treatment appointment.
Instead, the IME doctor will perform a physical examination and ask questions about your symptoms and treatment. Specific questions may be asked and testing may be performed to challenge reported limitations. Because the examination is arranged by the insurance carrier and used solely to obtain an opinion, many injured workers feel the process is rushed, incomplete, or dismissive.
After the examination, the physician reviews medical records and diagnostic studies before issuing a report containing their 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, an insurance carrier may request an IME approximately every six months or after a newly alleged work injury.
Insurance carriers often request IMEs when:
- A workers’ compensation claim has been denied
- An injured worker files litigation seeking benefits
- An injured worker is already receiving benefits
- The insurance carrier is considering filing litigation to stop or reduce benefits
Because of this, IMEs can arise at many different stages of a Pennsylvania workers’ compensation claim.
How Can an IME Affect Your Workers’ Compensation Benefits?
You may be surprised to learn that an IME can significantly affect your entitlement to workers’ compensation benefits.
An IME Can Be Used to Seek Termination of Benefits
An IME physician may conclude that you have fully recovered from your work injury and are capable of returning to work without restrictions.
If that happens, the insurance carrier may file a Petition to Terminate Workers’ Compensation Benefits. While the filing of a termination petition does not immediately stop benefits, it initiates litigation and places your wage-loss and medical benefits at risk.
An IME Can Be Used to Seek Suspension or Modification of Benefits
An IME physician may also conclude that you are not fully recovered but are capable of performing some type of work with restrictions.
If the employer offers work within those restrictions and you do not return to work, the insurance carrier may file:
- A Suspension Petition seeking to stop wage-loss benefits
- A Modification Petition seeking to reduce wage-loss benefits
Although these petitions do not immediately change benefits, they initiate litigation and place ongoing compensation at issue.
An IME Can Be Used to Deny a Claim
Most commonly, an IME is used to dispute liability for a denied workers’ compensation claim.
If the IME doctor concludes that you did not suffer a work injury and the Workers’ Compensation Judge finds that opinion credible, you may not be entitled to workers’ compensation benefits.
How Can a Workers’ Compensation Attorney Help With the IME Process?
A specialized and experienced workers’ compensation attorney can help prepare you for the examination and challenge unfavorable IME opinions.
Your attorney can help gather supportive medical evidence and cross-examine the IME physician when necessary. Proper preparation and legal representation can play an important role when an insurance carrier attempts to use an IME to challenge your claim or benefits.
Talk to a Pennsylvania Workers’ Compensation Lawyer
If you have been injured at work or are scheduled for an Independent Medical Exam, it is important to understand how the process may affect your workers’ compensation benefits.
At Stern & Cohen, our attorneys have extensive experience handling the IME process and challenging unfavorable opinions from IME physicians. Whether the insurance carrier is attempting to deny, suspend, modify, or terminate your benefits, our team is prepared to protect your rights and advocate for the compensation you deserve.
Contact Stern & Cohen today for a free consultation.
FAQs
Why does the insurance company request an IME?
Insurance carriers often request IMEs to obtain medical opinions that can be used in workers’ compensation litigation. The examination may address the cause of an injury, whether a worker has recovered, whether restrictions are necessary, or whether ongoing treatment should continue.
Can an IME affect my workers' compensation benefits?
Yes. An IME may be used by the insurance company to support a Petition to Terminate, Suspend, or Modify workers’ compensation benefits. It may also be used to dispute liability in a denied claim.
How often can the insurance company request an IME?
Generally, insurance carriers may request an Independent Medical Exam approximately every six months or after a newly alleged work injury.
What happens if the IME doctor says I am fully recovered?
If the IME physician concludes that you are fully recovered from your work injury, the insurance carrier may file a Petition to Terminate your workers’ compensation benefits.