The Impartial Medical Exam in Massachusetts Workers’ Compensation Cases

Chances are, if you have been injured in a work-related accident in Massachusetts and have filed a workers’ compensation claim, you may come across the need to attend an impartial medical exam. The laws in Massachusetts require an injured employee to attend an impartial medical exam at a specific stage of the workers’ compensation claim. This impartial exam should not be confused with an independent medical examination, which the insurance company typically pays for. The impartial examination is an unbiased examination and report.

Below is an overview of the impartial medical exam, including when they are required and how it may impact an employee’s workers’ compensation claim. If, after reading this article, you have questions about the impartial medical examination or any other questions regarding workers’ compensation, feel free to contact the attorneys at Mahaney & Pappas, LLP.

Basics of a Massachusetts Workers’ Compensation Claim

An employee who is injured on the job in Massachusetts is entitled to specific benefits from his or her employer’s workers’ compensation insurance carrier. Even though an employee may be entitled to these benefits, there are circumstances where an insurance company may deny or refuse to pay benefits. In the case where the insurance company denies a claim and refuses to pay benefits to the injured worker or modifies/terminates the benefits at some point, the worker has the right to file a claim for benefits.

When an injured employee files a claim for benefits with the Massachusetts Department of Industrial Accidents, the claim will proceed through the usual process of a Massachusetts workers’ compensation case. There are several levels of a claim. The first is the Conciliation. If claims cannot be resolved at a Conciliation, the claim will then proceed to a Conference.

A Conference is a formal oral argument before an administrative judge who will oversee and preside over the Conference. At the Conference, the injured employee (or his or her attorney) and the insurance company will submit medical records and other related evidence. After the Conference, the administrative judge will issue an Order. This Conference Order is binding upon the parties, but is generally considered to be a temporary order because any party aggrieved by the Conference Order has the right to appeal. When a Conference Order is timely appealed, the case will proceed to the next step in a Workers’ Compensation case, which is the Hearing.

A Hearing is the evidentiary hearing before the administrative judge, where witnesses are called to testify, and the administrative judge will render a decision on the case. Before the Hearing, however, the Department of Industrial Accident (DIA) will require the injured worker to attend an impartial medical exam.

Overview of the Impartial Medical Examination

As stated above, when a Conference Order is appealed by either party (the injured employee or the insurer), the case will proceed to a Hearing. The impartial medical examination will be scheduled and held before the Hearing.

Massachusetts General Laws, Chapter 152 §11(A) governs the impartial medical examination. The DIA in Massachusetts has a roster of impartial medical examiners who are certified specialists in various medical fields such as orthopedic surgery and neurology. An impartial physician has no relationship with, nor allegiance to, either party. Essentially, the DIA retains the impartial physician to serve as the judge's medical expert.

Section 11(A) states, generally, when any claim or complaint involving a dispute over medical issues is the subject of an appeal of a conference order…[the] administrative judge shall appoint [a medical] examiner [to examine the employee]. The impartial physician is provided with the medical records and documents that are submitted at the Conference in order to inform the impartial physician on the employee’s injury and medical treatment.

An examination by the impartial physician appointed by the DIA is then scheduled, which the employee is required to attend. The impartial medical examiner will then examine the injured employee. After the examination, the doctor will draft his or her impartial medical report at least one week prior to the beginning of the Hearing. The report will be provided to each party.

About the Impartial Medical Examination Report

Following the impartial medical examination, the impartial physician will prepare and issue a medical report. This report is generally referred to as the impartial medial report or the 11(A) report. The law states, the report of the impartial medical examiner shall, where feasible, contain a determination of the following: (i) whether or not a disability exists, (ii) whether or not any such disability is total or partial and permanent or temporary in nature, and (iii) whether or not within a reasonable degree of medical certainty any such disability has as its major or predominant contributing cause a personal injury arising out of and in the course of the employee’s employment.

In addition to the matters above, the report shall also indicate the impartial physician’s opinion as to whether or not the injured worker has reached a medical end result and what permanent impairments or losses of function have been discovered, if any. In other words, the impartial doctor will state what injuries the employee suffered, the cause of the injuries, if the employee is disabled and the extent of the disability.

The impartial physician’s report will be introduced into evidence at the Hearing and shall constitute prima facie evidence of the matters contained within the report. This means that the impartial medical report will control on all medical issues in the case. The highest court in Massachusetts, the Supreme Judicial Court has said that the examiner, "…as to the prescribed medical issues, stands in the position of a master or arbitrator who has considered medical evidence from both parties and whose determination of the medical issues the administrative judge reviews…" at the Hearing. 

If a party believes that the impartial report is inadequate, or the medical issues in the case are complex, that party may seek Court approval to allow additional medical evidence to be introduced into evidence at the hearing.

Speak With An Experienced Massachusetts Workers’ Compensation Attorney Today

If you have been injured on the job and have been ordered to attend an impartial medical examination you most likely have many questions.  If you are not sure what your rights are or what you are entitled to, you should speak with an experienced workers’ compensation attorney. 

Mahaney & Pappas, LLP has extensive experience in Massachusetts workers’ compensation claims. We specialize in helping injured workers get the benefits they deserve after being seriously injured on the job and will fight to protect your rights and get you the benefits you deserve.

Feel free to call us today at (508) 879-3500 or contact us online to schedule a free, no-obligation initial meeting and case evaluation.