Ways the Insurance Company Can Stop Your Workers’ Compensation Benefits – the Independent Medical Examination
A favorite tactic of insurance companies to stop both your weekly benefits and your right to ongoing medical care is to an “independent” medical examination or “IME.” This is usually a 5-10 minute “exam” by a doctor that is paid by the insurance company to examine you and issue a report regarding the status of your work injury. Because these doctors are paid by the insurance company, many times it is difficult for them to be “independent.” These doctors will often find that you are “fully recovered” from your work injury. If this occurs, the Employer will file what’s called a “termination petition.” There are, however, some things that you should be aware of in deciding how to approach the IME process.
Some Claimants will simply not go to the IME. If this happens you can just about guarantee a date with a workers’ compensation judge (WCJ). If you refuse to go, the WCJ will be required to determine if your refusal was a “reasonable refusal.” Frequently, Claimants will not attend IME’s because the appointment will be too far from their home or they do not have transportation to the appointment. However, if the appointment is far from your home, the workers’ compensation insurance company may pay for your mileage or even provide transportation for the appointment. You may have another good reason for not attending, however, if the Judge does not believe that your excuse is reasonable, the WCJ will issue an Order compelling you to attend the IME. If you refuse to attend the IME, your benefits can be suspended by an Order from the Judge until such time as you attend the exam.
If you do attend the IME you can bring, at your own expense, a “health care provider” to attend and observe the exam. The provider is not allowed to record the exam through video or audio recording or participate in any way, however, the provider can observe the exam and comment on it later if required.
Once you receive notice of the independent exam you should schedule an appointment with your treating doctor and confirm that the doctor will confirm your work injury is ongoing and will testify, if necessary, on your behalf. While the burden in a Termination petition is technically with the employer to establish that you are fully recovered from your work related injury, it’s not a bad idea to schedule a follow up with your doctor. The burden in a termination petition remains always with the Defendant to prove that all disability has ceased. This burden has always been found to be very high because your ongoing disability is presumed to continue until demonstrated to the contrary. The employer can prove the termination by showing 1) that there is an independent superseding cause for the disability that arose after the work injury was recognized; 2) it can state that all injuries now are due to pre-existing condition; 3) or they can state that your physical injuries have resolved. If the employer can produce an IME report that supports a termination, it would be in your best interests to have a doctor who can support your claim that you are not fully recovered from your work related injury.
You can hire an attorney to protect your ongoing compensation and prepare you for the inevitable litigation that will result from the “Independent Medical Exam”. Your attorney can address all of the issues discussed above and may have information about the credibility of your IME doctor. Some IME doctors are notorious “insurance company doctors” and some Judge’s will, in a close case, consider the reputation of that particular doctor which is good to know if you need to determine the likelihood of prevailing on a termination petition.
If you have been scheduled for an IME and have more questions about your options you should speak to an experienced Pennsylvania workers’ compensation attorney.
