If you have been injured on the job in Massachusetts and are receiving workers' compensation benefits from your employer’s insurance company, chances are, at some point, you will receive a notice to attend and submit to an independent medical exam (IME). Injured workers, who receive notices of an IME, have many questions. Here, we will focus on the IME and provide an overview of what is required of an injured employee and how an IME can impact a workers compensation claim.
What is an IME?
As the name implies, an IME is a medical examination set up by the workers’ compensation insurance carrier by an “independent” doctor that the insurance company chooses and pays. Specifically, Massachusetts General Laws, Chapter 152 § 45 states: “After an employee has received an injury, and from time to time thereafter during the continuance of his disability he shall, if requested by the insurer or insured, submit to an examination by a registered physician, furnished and paid for by the insurer or the insured.” The reasons we put independent in quotations, is because there is nothing independent about the insurance company’s doctors. Although, we would like to believe that, in the interest of fairness, the insurance company doctors provide unbiased opinions about the injured employee’s diagnosis and ability to work, the truth is that many insurance hired doctors will report what the insurance company wants. Usually, the insurance company wants a doctor to give an opinion that the injured employee is not disabled and is capable of returning to work. This way, an insurance company has some support to discontinue or reduce any disability checks an injured worker may be receiving in Massachusetts.
Do You Have To Attend An IME?
The short answer is: Yes. Chapter 152 Section 45 of our Massachusetts General Laws gives the workers compensation insurance company the legal right have an injured worker examined by a doctor that the insurance company chooses. This means that an injured employee is required by law to attend the IME.
The insurance company must provide the injured worker with proper notice of the IME, which must set forth the date, time, location and name of the IME doctor. Also, the location of the exam must be within a reasonable distance of the injured employee’s home.
If an injured worker receives notice of an IME, it is very important to attend. If an injured worker fails to attend the examination, his or her workers comp benefit checks could be suspended and the compensation may be forfeited during the suspension.
Our laws also provide that the workers compensation insurance company must reimburse the injured employee for reasonable travel expenses to the IME doctor’s office. If an employee cannot drive themselves, the insurance company must provide transportation to and from the IME.
How Will An IME Impact A Workers’ Compensation Claim?
The explanation of how an IME will impact a workers’ compensation claim is broken down into two different scenarios:
An Injured Worker Receiving Disability Benefits
If an injured employee is already receiving benefits, either voluntarily during the payment without prejudice period or after liability is established, an IME is used by a workers’ comp insurance company for a few different reasons.
In one situation, an insurance company may want to discontinue or terminate the payment of disability benefits to an injured employee. To do this, most insurance companies prefer to have some support for a request to discontinue the benefits. The support they want is a medical report from a doctor that gives the opinion the injured worker is not disabled and capable of returning to work. So, the workers comp insurance company will schedule an IME by a chosen and paid for doctor to get the report they want.
For Example: In a recent case our office handled, a nurse in a Massachusetts hospital slipped and fell on a wet floor and suffered a rotator cuff injury in her shoulder and a sprained MCL in her knee. The injured nurse’s doctors all say that she cannot return to work due to her injuries. This nurse was voluntarily paid disability benefits for the first four months from her accident. The workers’ compensation adjuster scheduled an IME for this injured nurse, which she attended. The IME report claimed that she had been injured in the slip and fall accident, but that she was not disabled and could return to work. As soon as the insurance adjuster received the IME report, the injured nurse received a notice that her disability benefits would be terminated.
Also, a workers’ compensation insurance company may use an IME report to modify disability benefits from temporary total disability to temporary partial disability. This occurs when the IME doctor concludes the injured worker is not totally disabled, but is capable of returning to work on light duty.
An insurance company may also use an IME report to contest or deny medical benefits or a medical procedure, such as a surgery requested by an injured worker’s treating doctor. In this situation, the insurance company seeks an opinion by their doctor that the injured worker does not need surgery or that the surgery is for an injury or medical condition that is unrelated to the work accident.
For Example: We had a client that had suffered a serious hip injury in a work accident in Boston, Massachusetts. The employee’s treating hip doctor recommended a total hip arthroplasty (replacement) due to the injury. The employee’s doctor stated that the injury was consistent with severe to near-end stage post traumatic osteoarthritis (OA) in the right hip and that the work accident was a major cause of the progressive hip changes. The workers’ compensation insurance company sent this injured worker to an IME. The IME doctor claimed that the hip issue was from arthritis, a degenerative change, which is not related to the work accident. Based on the IME, the insurance company denied the requested hip replacement. This employee suffered on a painful hip until we were able to obtain an order from the DIA Judge requiring the insurance company to pay for the surgery.
An Injured Worker Filed a Claim For Disability Benefits
If an injured worker had to file a Claim for Benefits because the workers’ compensation insurance company refused to pay disability benefits, an IME is usually scheduled by the insurance company. This is so they can get a medical report to use at Court to argue that the injured worker should not entitled to disability benefits.
How Should An Injured Worker Prepare For The IME?
If an injured worker receives a notice to attend an IME, he or she should be aware of a few ground rules before the examination. This is where an experienced workers’ compensation attorney is helpful. An employee’s lawyer can help advise the injured worker about their injury and what to do, say or not do and say at the IME. Here are a few tips:
- An injured worker should be familiar with their doctor’s diagnosis and work restrictions. In preparation, the injured employee should consult with their lawyer or, if they don’t have a lawyer yet, review their own medical records. This way, they can be prepared to answer some of the IME doctor’s questions.
- The injured worker should not ask the IME doctor for medical advice. The IME doctor is not the employee’s treating physician, but is hired by the insurance company. Their opinion may be completely different than an employee’s treating doctors.
- Try to avoid exaggerating the injury or restrictions. An injured worker, who attends and IME and embellishes their injury and physical restrictions, will not help their claim. The IME doctor, in some situations, will write in their report that the employee was faking or exaggerating their disability. The IME report could be used in Court at a later date and can have a negative impact on the employee’s claim.
- If possible, try and schedule an appointment with your own treating doctor for the same day or within a day or two, of the IME. This way, you can have a medical record from your own doctor close in time to the IME that may contradict and disprove the IME doctor’s opinion or observations of the employee’s abilities.
- Always be courteous and respectful to the IME doctor, regardless of how the doctor acts. There is never a situation where being rude and disrespectful to an IME doctor will help a workers comp claim.
Injured Employees Should Get Legal Help
If an employee is injured in a work accident in Massachusetts and receives notice of an IME, he or she should contact an experienced workers’ compensation lawyer. An experienced attorney will help properly advise the injured worker, protect their rights, and guide them through, the sometimes adversarial, workers’ compensation process. An injured worker should not seek advice from the insurance adjuster or the IME doctor. They are working for the insurance company and do not have the injured employee’s best interest in mind.
We accept workers’ compensation cases on a contingent fee basis. This means that an injured employee does not have to pay a deposit for legal fees upfront. So, an injured worker can retain a lawyer and get legal advice before an IME without having to come up with a retainer.
Mahaney & Pappas, LLP have been working with and helping injured employees in Massachusetts for many years get the benefits and settlements they deserve. Our results speak for themselves. Feel free to contact us online or call (508) 879-3500 to schedule a free meeting to discuss your work accident. We are happy to provide you with a complimentary case evaluation.