What is an independent medical evaluation?

In a Utah workers comp claim, a doctor’s opinion can be even more important than a judge’s opinion.

Doctors hold the key to your claim, and insurance companies know this.

Why do I need to attend an IME for my Utah workers comp claim?

When you’re hurt at work, your insurer will do everything possible to save money.

First, they’ll try to send you to a doctor in the insurer’s own network. The insurance company has already negotiated a rate with this doctor in advance.

You’ll visit the insurance company’s recommended doctor for an Independent Medical Evaluation/Examination—otherwise known as an IME.

But after your doctor visit, you might think the name is “Insurance” Medical Examination. Here’s why.

What happens at an IME?

Insurance companies know how powerful your doctor’s opinion is. Claims adjusters commonly select doctors who have a track record of helping them close cases as quickly as possible (to your detriment).

IME doctors are usually NOT neutral, independent, or objective.

Instead, they act as paid witnesses for the insurance company.

Whatever you say to this IME doctor can and will be used against you. The IME doctor wants to minimize the extent and severity of your injuries.

Even worse, some insurance companies have been known to hire private investigators to monitor you on your way to the doctor and back.

Sometimes these investigators even film you in the process.

Remember, the insurance company is NOT your friend—they’ll try to save money by any means necessary.

What kind of questions will they ask at an IME?

Some of the questions you could be asked at an independent medical evaluation include:

• Is your injury really caused by a work-related accident? Is it possible that off-duty or personal activities are the true cause of your symptoms?
• Do you actually have the condition that you claim to have? Has your illness or injury been properly diagnosed?
• Are recommended treatments actually necessary? Will you need additional treatment?
• Do you have any permanent disabilities?
• Can you return to work? If so, when? And will you need any duty restrictions once you return?

You’ve probably noticed a theme—the questions are focused on your claim, not your health. Insurance companies expect IME doctors to fish for information that can deny your claim.

Can I trust an IME doctor?

You shouldn’t expect any type of standard patient-physician relationship from your IME doctor.

Anything you say to the doctor is not protected or privileged. Expect whatever you say to be used against you.

What happens after an IME?

After your medical examination, your doctor will write a report regarding your injuries.

The report will contain his or her opinions, particularly regarding the issues relevant to your workers compensation claim.

IME reports often have a significant impact on workers comp cases.

Many times, your case’s judge will consider the IME doctor an expert.

But if the IME doctor’s report or opinion seems biased against you, you still have options.

Rebutting an IME designed to sink your case

There are two great ways to strengthen your case against a biased IME report.

Choose your own treating doctor

In Utah, you have the opportunity to choose your own medical provider.

You may be required to visit the insurance company’s treating doctor the first time, but you are allowed to make a change of physician–once–without the insurance company’s permission or a referral from their doctor.

After you change physicians once, you may only change doctors again if your treating doctor refers you to someone else (or to a specialist).

Get a true independent evaluation

Sometimes, showing your treating doctor the conclusions of the IME doctor will make him so angry that he’ll gladly write a rebuttal or contrary opinion on your behalf.

Hire a workers compensation lawyer

There’s actually a third way to fight against the IME’s bullying tactics—hiring a workers compensation lawyer.

Have you recently attended a biased IME? Did you insurance company ask you to undergo an IME soon? Are you being taken advantage of by the insurance company or their doctor?

If so, contact Davis & Sanchez immediately. We’ll help you figure out the next step—and decide the best path to winning the compensation you deserve.