How a Second Opinion Could Help You Get the Benefits You Deserve
Your treating doctor’s opinion is one of the most important parts of your workers’ compensation case. But what happens when you believe they are wrong?
That’s when an independent medical evaluation, or IME, comes into play. An independent medical evaluation is an exam that’s meant to help resolve disputes in your workers’ comp case. The term is sometimes used to refer to exams requested by your employer’s insurance company to evaluate your claim. However, an IME is also a tool that you as an employee can use to fight an unfair disability rating.
The experienced Iowa workers’ compensation attorneys at Schott Mauss & Associates have spent years helping Iowa workers earn the benefits they deserve. Part of this includes advising our clients how to prepare for IMEs and when to request them.
If you’ve been ordered to attend an insurance exam or you’re considering getting a second opinion, read our guide on the two types of IMEs and how they work.
What Is an Independent Medical Evaluation (IME)?
The term “independent medical evaluation” is sometimes used to refer to two very different types of exams. The main difference lies in who is requesting them.
1. The Insurance Company’s Exam
Throughout the workers’ compensation process, your employer or their insurer generally has the right to choose your medical provider. After you file your workers’ compensation claim, they may request an initial exam to evaluate the claim. While they may call the exam “independent,” you should know that the doctor is hired by the insurer to evaluate your claim and may have an established relationship with the insurance company. Attendance at this exam is required. Failing to show up could result in a loss of benefits.
2. Your Right to a Second Opinion
The second type of IME is available to you, the employee, at a certain point in the workers’ comp process.
Once your condition has stabilized, your employer’s chosen doctor will say you have reached the point of maximum medical improvement (MMI). When you reach MMI, your employer will likely ask the doctor to assign a permanent impairment rating. This rating, expressed as a percentage, is an attempt to quantify how much of a loss you have suffered from your injury. This will affect the level of disability benefits you receive in the future.
When you receive your permanent impairment rating, you may believe it’s too low and doesn’t accurately reflect your injury or limitations. In this case, you don’t have to accept it as the end of your case.
Iowa law allows you to requestan independent medical evaluation from your chosen doctor. If you believe your permanent impairment rating is too low or that you are not receiving adequate medical care, the IME can serve as evidence that you should receive more benefits.
What Should I Expect at My IME?
The independent medical evaluation may seem like a major step in your case, but you don’t have to be nervous. The appointment generally functions like a normal doctor’s appointment. However, the goal is not to treat you but to check your current health.
The doctor will likely ask questions about your injury, pain, and limitations. These questions could include what level of pain you experience, what daily tasks you can perform, and what aggravates your injury.
They will likely conduct a medical assessment of your injury. This may include some lab or diagnostic tests, if needed.
At each step, it’s important to answer the IME doctor truthfully and clearly. Provide accurate information that describes your injury as fully as possible.
What Happens After an IME?
Following an employee-requested independent medical evaluation, the doctor will write up a report. This opinion may be used by the Iowa Workers’ Compensation Commissioner as evidence to resolve the dispute in your case.
Tips for a Successful Independent Medical Evaluation
How do you make sure your IME goes well? Here are some basic tips from our attorneys.
Do: Prepare for Your Appointment
Being prepared will help you present your health care situation in the most accurate light. This will ensure you don’t leave out any important details that could help your case. Before you go to the doctor, write down the following:
- Your symptoms
- Your limitations
- Where you’re having pain and how severe it is
- Any questions you have about your condition
Don’t: Request an IME Before Speaking With an Attorney
It’s best to start working with a qualified workers’ compensation attorney early in the application process. If you haven’t yet, it’s very important to work with one by the time you are considering an independent medical evaluation. An attorney can help advise you when to request an evaluation and how to prepare so that your case is presented in the best way possible.
Do: Be Truthful About Your Injury, Your Limitations & Your Pain
Lying to make your injury and pain sound more severe is one of the top mistakes we recommend avoiding in a workers’ comp case. However, so is downplaying your pain. Even if you’re having a “good day” at the time of your appointment, it’s also important to let the doctor know what a “bad day” feels like.
The best advice: Be honest with every doctor you speak with. Anything less than the truth has the chance to hurt your case more than help it. It’s also good to keep your remarks focused on your condition. Avoid talking about any negative feelings toward your employer or how much money you hope to earn from your case. Anything you say during this appointment could affect your case positively or negatively.
Don’t: Miss Your IME Appointment
Refusing an employer-requested exam will hurt your case. Iowa law states that if you refuse a reasonable request for an exam, your right to weekly benefits is forfeited until you comply. If you must miss the appointment, make sure to call in advance to reschedule and let your attorney know first.
Frequently Asked Questions About IMEs
Who Pays for an Independent Medical Evaluation?
Generally, your employer. Once you’ve received a permanent impairment rating, you can request an IME and be reimbursed for the cost. This also includes transportation expenses. It’s important to know that the law doesn’t allow for this evaluation until after you’ve received a permanent impairment rating from the employer-chosen doctor. If you go to your own doctor before then, you could be left paying the bill yourself.
Can You Refuse an Independent Medical Evaluation?
Not if your employer requests it. It’s important to not refuse any evaluations requested by your employer or their insurer. This could cause you to lose your benefits.
However, you as an employee do not have to request your own independent medical evaluation after you receive a permanent impairment rating. This is particularly true if you are content with your treating doctor’s evaluation of your injury. It’s best to make this decision with the advice of an attorney.
Let’s Secure the Workers’ Comp Benefits You Deserve
If you have questions about independent medical evaluations or any other aspect of the Iowa workers’ compensation process, we are ready to partner with you. Schott Mauss & Associates will work with you to file your initial claim, appeal a denial, or anything in between. Contact us today for a free consultation.
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