Wednesday, March 30, 2016

The "Independent Medical Exam" (IME)

Sooner or later the workers compensation insurance adjustor may send you to see her doctor for an "independent medical exam" or IME.  These appointments are typically in St. George or in the Salt Lake City area, so the adjustor needs to send you a check to cover gas and meals in advance.

Who is the IME doctor?  The IME doctor is paid by the insurance company.  He or she is paid to review your medical records, conduct a physical examination and then write a report.  The adjustor may then use the IME report as a basis for denying any further benefits, i.e., cutting off lost wages (temporary total disability benefits), or denying further medical treatment, i.e., prescriptions.  If the injured worker fails to attend the IME appointment, the adjustor may deny further benefits due to "lack of cooperation" as required by Utah law.

The Questionnaire:  The IME doctor will often ask the injured worker to fill out a questionnaire.  Remember these three things:  (1)  When filling out the questionnaire, please be very careful to be thorough--include all of your symptoms, limitations, fluctuations, etc.  For example, on the pain scale, be sure to explain whether your pain fluctuates depending on exertion or time of day.  Sometimes sitting or standing or bending make the pain worse.  If so, be sure to be specific.  (2)  Also, be cautious of what you say.  IME doctors typically will quote hyperbole--dramatic things you say like, "I'm dying!"--to attack your credibility.  Your credibility is important because there's money involved and the insurance company wants to save money.  (3)  Also, the questionnaire will often include a pain drawing where you mark the location of your pain on the outline of a human body.  Be sure to be very specific and careful of where you mark, and be sure to include little notes about when and where the pain is because most of us are not artists and the doctor will use any discrepancy against you.  For example, if you say your neck hurts but you do not mark it on your pain drawing, then the doctor will conclude that your neck does not really hurt.  Again, be consistent and specific and explain yourself.

Rebutting the IME:  Sometimes, the IME will recommend further treatment or testing, e.g., a nerve conduction study.  Almost always, IME doctors will recommend that opiates be tapered off and non-narcotic pain medications used instead.  If the IME doctor makes incorrect assumptions or conclusions, it is usually helpful to give a copy of the IME report to your treating doctor and ask your treating doctor to comment on or rebut the IME report.  A rebuttal can be very helpful to your case, especially if your treating doctor is a specialist and really knows what he or she is talking about.

The Appointment:  If you receive a notice of an IME appointment and know you won't be available that day, then promptly notify the adjustor and the IME doctor's office and have the appointment rescheduled.

Have a Plan B:  Again, adjustors are trying to save money and minimize benefits paid to injured workers.  It behooves injured workers not to rely on the adjustor's payment of benefits.  Be thinking and talking with your spouse, "If the adjustor cuts off benefits, how will we get by financially?"  The Boy Scout motto is "be prepared," which is wise counsel.

If you have any questions, call me at (435) 592-1235 or visit