Employees suffering from a work-related injury, disability or illness are often required to have an Independent Medical Exam (or IME).
What is an Independent Medical Exam?
If you become injured or disabled at work and have an open L&I claim, the Department of Labor and Industries may require you to submit to an Independent Medical Exam. Many workers believe that the exam is impartial owing to the word “independent” in the name of this procedure. Unfortunately, this is not always the case. In fact, some workers’ advocates claim that “it would be a lot more accurate to call the exam an Insurance Medical Exam because it is done by, for, and to benefit the insurance company. Unfortunately, insurance carriers are not looking for an independent evaluation.”
This is not exactly correct in all cases, but there is a certain kernel of truth to the charge. Most “Independent” Medical Exams are performed by doctors (or other medical professionals) who depend on the IME for a substantial part of their income. IME physicians understand that the Department of Labor and Industries has no overwhelming incentive to find you injured or disabled.
In any case, the general sentiment that Independent Medical Exam physicians are biased in favor of L&I is prevalent enough that many IME groups address the stereotype head-on. One Independent Medical Exam website offers the following disclaimer that “While we can’t answer for physicians elsewhere, our physicians are all board-certified, in private practice with injured patients of their own to care for. They are not ‘paid by the State’ (or anyone else), but by us. We allow no pressure of any kind to be brought to bear on our specialists, either by referral sources, or, for that matter, by anyone else. Our physicians have no incentive to offer a biased opinion; financial or otherwise, nor will we permit any attempt to influence their best medical judgment. Their financial relationship is with us, not the referral source; they have no reason to “please” the referral as they have no financial contact with the referral source. We see our primary task as providing an influence-free environment for every evaluation.”
Furthermore the IME source claims that “Our physicians will be responding to questions provided by the referral source; however, this does not mean that the interests of the referral source will prevail or drive their conclusions in any manner. The sole purpose is to provide a current, thorough, medical evaluation of your injury or condition, without influence of any kind.” Such defenses are commonly heard when concerns are raised about the impartiality of the Independent Medical Exam process, although such claims themselves are not usually supported with evidence that convinces critics of the IME system.
An L&I Washington Law Firm raises the following doubts about such statements of defense: “Most medical professionals who perform IME’s for insurance carriers usually do so on a regular basis either in a direct relationship with the carrier or with a third-party IME service, and this gives them a vested interest in finding disabled claimants healthy and able-bodied – they consider it job security. These medical professionals seek to tell the insurance carriers (their customers) what the insurance carriers want to hear, i.e., that the patient is medically fine and not entitled to disability benefits. They know that if they perform an independent examination and find the claimant to be disabled, it will lead to less repeat business from the insurance carrier, or carriers. In the end, the IME doctor most often chooses to keep his or her customer happy by giving them what they want – a medical report which supports denying the claim.”
What happens at an Independent Medical Evaluation?
The IME usually begins with a record review. Before patients even meet the IME doctor, Labor & Industries staff who are reviewing your L&I claim have already scrutinized your medical records, and may provide only selective records to the IME doctor for review. Records that have been taken out of context can create the appearance that your medical condition isn’t as serious as it might be, or that medical evidence is contradictory or ambiguous. As a result, even if an IME doctor would otherwise be inclined towards impartiality, he or she is only provided with pre-screened information.
Another fairly common practice among some IME doctors is to look for “holes” in your medical record. Something as simple as an accidental omission on the part of your treating physician can result in an IME doctor deciding that your medical report does not support your disability claim.
Many patients report that even when the exam finally occurs, it can seem rather superficial. IMEs often last only a few minutes – which many find surprising given the extensiveness of an IME doctor’s report and the long list of clinical testing the doctor supposedly performed. If you have been scheduled for an Independent Medical Exam, don’t expect a thorough exam.
Other Problems with the IME
Another problem with the system is that many IME professionals have preconceptions about certain medical conditions common among workers with disabilities and injuries. Some IME doctors entirely dismiss debilitating conditions like chronic fatigue syndrome or fibromyalgia because these illnesses are difficult to detect through CT-scans, MRIs and other diagnostic procedures. This is unsurprising when you consider that most IME doctors spend much of their time performing IMEs. Unlike primary physicians (your own doctor), who generally examine and treat patients over extended lengths of time, doctors specializing in Independent Medical Exams basically see a mere snapshot of the patient’s medical condition. This means an IME doctor can only assess the claimant’s condition for that single medical visit required by the Department of Labor and Industries.
The fact is that many occupational illnesses or medical conditions can only be diagnosed over long periods of time involving many clinical visits that track developments in a patient’s symptoms and test results. Given their highly restricted interaction with the patient (along with their general bias), it is expectable that so many IME doctors doubt the injured worker’s condition and disregard reported symptoms like headaches, dizziness, pain or numbness.
Is the Independent Medical Exam Required?
Employees with an L&I claim cannot refuse an Independent Medical Exam. If they do, it is likely that the Department of Labor and Industries will automatically reject your L&I claim or terminate your benefits. However, workers can minimize negative consequences from this procedure with the help of a knowledgeable L&I attorney. Emery Reddy counsels clients in advance of the Independent Medical Exam. We can also send a trained professional to accompany you to your medical examination. This sends a clear message to the independent medical professional that a law firm is paying attention to their assessment. In observing everything that happens during the IME, the professional will also report to an Emery Reddy attorney, and determine whether the IME doctor completed the clinical tests he or she claims to have performed.
When applying for benefits in an L&I claim, Independent Medical Exams can be an unfortunate and unavoidable fact. But this doesn’t mean you must become a victim. Contact Emery Reddy for a free case evaluation and assistance with your L&I claim.
Washington’s Department of Labor & Industries has now begun to accept applications for the state workers’ compensation medical network, which will launch in 2013. Network providers will give medical care to injured workers covered by L&I policies as well as those with self-insured employers.
