Why Is My Workman's Comp Insurance Company Ordering an Independent Medical Examination?

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Your claims examiner may legally schedule you for an independent medical examination.
Your claims examiner may legally schedule you for an independent medical examination. (Image: Jupiterimages/Photos.com/Getty Images)

Workers’ compensation insurance is an insurance program that places no blame and provides medical treatment and disability payments for lost-time wages. Each state sets codes and laws that determine how workers’ compensation is handled within the state. In all cases, employers must provide this protection to their employee. Employees receive certain benefits under workers’ compensation coverage, but claims examiners and the insurance carrier are legally entitled to certain guarantees as well.

First Report of Injury

An employee who receives an injury must report this injury within a certain period as defined by the state in which the work commenced. Some states, such as California, allow up to a year to make this report of injury, but it is best to report any work-related injury immediately to receive the needed benefits. Claims reported well after the injury date often receive a red flag for possible fraud.

Medical Treatment

When you have a work-related injury, inform the doctor that the injury occurred during work. This sets in motion of series of reports the doctor must complete to report the injury. Some states allow the report of injury to come from the doctor and later from the employee. In any case, to receive the medical treatment without paying for it yourself, report to the doctor the work-related injury. He sends his report to your employer’s workers’ compensation carrier. If the report does not meet the standards required for proper evaluation under state laws, the claims examiner may request an independent medical examination.

Treatment Options

Some states allow you to choose your doctor before an injury occurs by filling out a pre-designation form, and some allow you to go to your own doctor for the injury. Other states require that you receive care from a specified clinic or doctor. Check with your employer to ascertain how this works in your state. In all cases, workers’ compensation carriers are entitled to independent medical evaluations if they feel they are necessary.

Independent Medical Examination

When a doctor is unclear as to the state of the injury or the claims examiners questions the length or treatment or the doctor’s reported disability rating, the claims examiner assigns an independent medical examination. You receive notice from the claims examiner regarding a new appointment to undergo an independent medical examination. Depending on the nature of the injury, such as when several bodily systems are involved, you may need to attend multiple evaluations with different specialists. To continue to receive medical benefits, you must attend the requested examinations.

IME Reasoning

An independent medical evaluation (IME) allows the claims examiner and the workers’ compensation carrier to make the most informed decision when it comes to your medical treatment. Having more than one medical opinion assures your best interests as well as the interests of the carrier. An IME allows for proper disability ratings, evaluations and treatments.

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