May 28, 2017

“Independent” Medical Exams Scheduled by the Insurance Company are Rarely Legitimate

Funny Doctor breaks the bad newsA very common tactic used by workers’compensation insurance companies to cut off your benefits involves the use of something called an “independent medical exam” or IME.  As you might guess, in my experience these medical evaluations are rarely independent and they often serve no purpose other than medical support for termination of benefits.

Fortunately, most of the State Board judges that consider workers’ comp issues understand how the IME game works, and they look at these results with a very critical eye, but insurance adjusters continue to use this practice as a matter of course.

When I get an IME notice, the first thing I will look for is the name of the examining doctor.  There are a number of physicians out there who work extensively for the insurance industry and in almost every file sent to one of these doctors, the resulting report will minimize the extent and nature of the work injury, question the relation of injury to the accident at work , and suggest that a full duty return to work is appropriate.

Because the insurance company has the right to send you out for one of these biased IMEs, you have no choice but to go.  I can usually predict what the forthcoming report will say and that the insurance company is planning to try to cut you off, so I gear up to request a hearing challenging the proposed cut off.

The file will end up on the desk of a defense lawyer who I most likely know.  He or she and I will talk and acknowledge that the insurance IME was a waste of time and we will either start to discuss settlement, or try to agree on a more unbiased doctor to see you.

Recently I represented a client who went through the IME exercise, but with a different twist.   In this case, my client was working for a temporary agency when he injured himself in a bad fall.  Interestingly the industrial clinic doctor on the posted panel recommended a referral to an orthopedist and a neurologist.

The IME doctor conducted a 5 minute exam and issued his standard report stating that my client had no significant medical issues and could return to work.  The report also contained an interesting statement that my client had left his previous temp. assignment because it was too physically demanding.

In fact, my client had left his previous assignment because that assignment had ended.  The temp agency had sent him to a new job site where he incurred the injury that for which I was representing him.

It appears to me that the IME doctor threw in this erroneous comment about the previous job being too demanding solely for the purpose of implying that my client had a pre-existing condition or to question his honesty.  In any case, my client insisted to me that he said no such thing about his previous job because the doctor’s assertion was not true and because there was very little conversation during the 5 minute exam.

In this particular case, the defense attorney recognizes the uselessness of the insurance IME but if we were go end up at a hearing, I would cite the doctor’s gratuitous misrepresentation as evidence of his bias and untrustworthiness.

Because I worked for an insurance defense firm for the first 6 year of my legal career and have represented injured workers for the past 20+ years, I know how the IME game is played and how to deal with these questionable reports.  And, in case you were wondering, this “IME problem” is not unique to Georgia – workers’ compensation lawyers throughout the country regularly report their own horror stories.

If you are not represented and the insurance adjuster wants to schedule you for an “independent” medical exam, I’d be happy to offer my insight.  You can reach me directly at 770-351-0801.

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Jodi Ginsberg

Attorney Jodi Ginsberg represents employees who are injured on the job and who need medical care and missed wage benefits available under Georgia's workers' compensation laws.

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