If you experience a work-related accident, illness, or medical condition, and your employer participates in Arizona’s system for workers’ compensation insurance, then there is a chance your employer’s workers comp insurance company may want to have you undergo an independent medical examination (IME).
The Arizona system for workers’ compensation allows an insurance company to make this request of an injured worker.
Depending on the results of an independent medical examination, you may find yourself facing challenges to your claim that can go all the way up to claim denial.
If this happens, you should hire an experienced workers’ compensation lawyer immediately. Call Matt Fendon Law Group at (800) 229-3880 today or contact us online to protect your claim from being reduced because of an unfavorable IME result.
What Is the Reason for Independent Medical Examinations?
A workers’ compensation insurer is most likely to ask an injured or ill employee to undergo an independent medical examination when it has questions or disagreements about the worker’s medical history or the nature of the injury, illness, or condition.
These questions can be about the severity or extent of your injury, your treatment, whether it was work-related or caused by another source, or if it is a pre-existing condition.
Insurers often request independent medical examinations after serious injury events like an automobile crash or an accident that is likely to result in injuries requiring long-term treatment.
Claims for injured workers that workers comp insurance professionals consider “mega” claims—claims that can cost more than $10 million to treat—are almost certain to trigger an IME request.
An independent medical evaluation is a way for the insurance company to safeguard itself from the possibility of incorrect, exaggerated, and fraudulent Arizona workers’ compensation benefits claims. Independent medical examiners serve a public purpose as well as a protective one for the insurer.
How Does an Independent Medical Examination in Arizona Work?
If your employer’s insurer wants you to undergo an IME, it will send you a request to attend a scheduled appointment with an IME doctor it chooses. It is important that you do not disregard this request.
The request is actually an order: you must attend an IME if the insurer wants one. Failing to undergo an IME can seriously and negatively affect your claim.
Course of the Examination
Before the IME, the IME doctor will likely request your medical history by reviewing medical records from your doctor.
During the IME, the examiner will go over your medical records, ask you some questions about your current injury, illness, or condition and about any previous injuries, and perform an examination on you. You may also be asked to undergo some physical tests.
Some of the medical information the independent medical examiner might inquire about can include:
- Your relevant medical records from your own doctor
- The nature of your injury and how it happened
- The possible duration of your injury
- What kind of treatment your treating doctor has recommended
- When you think you can return to work
After the medical evaluation, the doctor will prepare a report for the employer’s insurance company.
If you cannot attend the insurer’s initially scheduled IME, then you or your workers’ compensation attorney will need to work with the insurer to arrange for a better date and time.
How the Medical Examiner Relates to You
You and the independent doctor who performs your IME do not have a patient-physician relationship. The insurance company or your employer’s attorney will hire the IME examiner.
This means you must be careful how you present yourself to the medical examiner and what you say.
At best, the IME doctor will be disinterested in your medical condition. At worst, the doctor could act as someone being paid by a workers’ compensation insurer who is looking for an excuse to minimize the seriousness of your injuries and to reduce or deny your treatment.
How to Get Through an IME
Because your independent medical examination can have such a serious impact on your Arizona workers’ compensation benefits, you must approach the examination seriously.
Here are some tips to help you prepare for your IME, including what to do and avoid doing during the exam.
Before Your IME
- Make your IME appointment on time. If you cannot make your scheduled IME appointment, then you must inform the insurer in a timely way (if you have a workers’ compensation attorney, you can inform your lawyer instead). If you miss your appointment, cancel it without attempting to reschedule, or you are late to your IME, then the examiner might reflect this in the IME report and this could work against you. Also, you could be charged for a missed appointment.
- Understand the reason for the IME. Your employer’s insurance company will only schedule one for you if it has questions or doubts about your workers’ compensation benefit claim. While your independent medical examiner is not an adversarial meeting between you and the IME doctor, know that the doctor will be focusing on those areas of questions or doubts. Your workers’ compensation attorney can help you understand the key medical issues for your IME before the exam.
- Complete any examination forms carefully and completely. The examination forms will ask you about your accident at work, the injuries you suffered, and any medical treatment you have received. Answer these questions honestly. There is no need to overstate the injury or your symptoms; if the IME doctor believes that you are exaggerating them, then the doctor may note that in the IME report.
- If you have not yet received medical treatment or have gaps in your treatment record, explain these truthfully. Your workers’ compensation attorney can help you obtain these IME forms before your examination and help you to fill them out.
During Your IME Visit
- Know that you are being scrutinized. IME doctors are experienced observers not only of medical records and medical symptoms but also of your general appearance and demeanor. They will look for behaviors that suggest exaggeration or faking of symptoms or other signs of dishonesty.
- Be yourself. You are not “on trial” in an independent medical exam but remember that the insurance company pays IME doctors to look out for its interests, not yours. You have only limited doctor-patient confidentiality with the IME doctor.
- Be careful about what you say to the examiner. The IME doctor is not your treating doctor. You have no doctor-patient relationship. You need to answer any questions the IME doctor asks you truthfully. But you do not need to volunteer more information than the doctor asks for.
- Answer the examiner concisely. If the IME doctor wants more information, let the doctor ask follow-up questions. Do not discuss any conversations you have with your workers’ compensation lawyer. These communications are legally privileged and the IME doctor has no reason to ask you about them.
- Be careful about what you ask of the examiner. The IME doctor’s job is to simply gather information about your injury and report to the insurance company. You should not expect the IME doctor to have any opinion about your medical diagnosis, any additional medical treatment you may need, or your prognosis. If you have questions about the IME, it is better to save them during the examination and to ask your workers’ compensation lawyer later.
What Happens After the IME
After the IME, the IME doctor will report the examination results to the insurance company. This process can take up to two weeks.
The importance of the IME report is hard to overstate. The insurance company will almost certainly use an adverse report to press for a reduction in the Arizona workers’ comp benefits you need. Moreover, if you must appeal a benefit claim denial, at least in part because of an IME report, many judges give significant weight to IME examiner reports.
This is why it is important for you and your workers’ compensation attorney to request in writing and obtain a copy of the IME report so you can respond effectively to it if the insurance company is using the report to low-ball your benefits claim and your treatment.
IME-Based Claim Denials: What to Do
Independent medical examinations can be the cause of your Arizona workers’ compensation claims being reduced or denied in one of two ways:
- You did not attend your independent medical examination.
- If you did, the IME doctor drew one or more adverse conclusions from your examination.
For example, the doctor might report that:
- Your injury, illness, or condition was not because of a work-related incident (such as a pre-existing injury)
- The injury happened when you were not acting as an employee.
- The injury happened because you were doing something that made the accident your fault (for example, failing to follow safety rules, improperly operating a vehicle, machinery, or equipment, engaging in unauthorized behaviors on the job, or being under the influence of alcohol or a controlled substance when the incident happened).
If your Arizona workers’ compensation benefits claim is denied, you can challenge that denial. There are several ways that IME doctors can write a negative report that is not an accurate description of your injury or its cause.
Call Matt Fendon Law Group Before Your IME
If your workers’ comp claim has been denied or if you are preparing for an IME, contact the Matt Fendon Law Group immediately to discuss your legal rights.
For injured workers, challenging an Arizona workers’ compensation claim denial is a formal procedure that includes documentation and a hearing before a workers’ compensation judge, and it has strict rules you must follow to preserve your appeal rights.
Our Arizona workers’ compensation attorneys can help you navigate the complicated claims process in time, so you do not lose your workers’ compensation case because of a technicality.
Call us today at (800) 229-3880 to speak with one of our Arizona workers’ compensation lawyers. We can help you prepare for an IME, or if your claim is denied because of your IME report, we can represent you in your workers’ compensation case appeal.
