Firm-Wide blog

Independent Medical Exams Aren’t as “Independent” as You Might Think.

By Burg Simpson
January 5, 2015
3 min read

When you get hurt at work, the decision about which doctor you’ll see is usually made by the insurance company. You can’t just go see your regular family doctor for a visit about your work injury. The employer should give you a choice of at least two doctors or clinics to see and sometimes will schedule an appointment for you. They should either reimburse you for travel expenses or provide transportation for you to all of your appointments, so keep track of your mileage. Frequently, once treatment has been going on for a while the insurance adjuster you may ask for a second opinion or the adjuster may tell you that you’re going to an “independent” doctor, but the reality is usually very different.

Insurance companies like to work with the same doctors they are used to seeing. There are a lot of reasons for them to use their usual connections, but the most important reason is that those doctors frequently side with the insurance company when they do an evaluation. They will often collect information about your medical history and build a strong case against you by saying you have a “pre-existing” condition or don’t need a surgery that your doctor has suggested. Doctors for Independent Medical Exams (IMEs) are commonly well-coached by insurance providers to look for things in your medical history that may seem unrelated to your current injury but can provide an argument of “prior injury” in your case. If you don’t have a lawyer, the doctor is also able to share information about your visit freely with the insurance adjuster.

I have dealt with cases where my client was living in Gunnison or Grand Junction and forced to travel hundreds of miles to Denver for a 45 minute consultation. My client is left wondering why the insurance company didn’t use a doctor closer to them. It’s an unfair burden placed on people who have been injured, but the ultimate goal is to be in control of your treatment plan. Unfortunately, this is the way the system works, and it likely won’t change any time soon. There are a few things you should keep in mind to make sure you get the most out of IMEs:

  • Be aware of what information you share in your appointment. They are allowed to ask about your prior injuries to the same part of the body but may not necessarily be able to ask about unrelated illnesses or injuries.
  • Have a lawyer on your case before your first medical visit, and inform the doctor that you have counsel. This will stop the doctor from being able to share any gathered information about you with the adjuster without notifying your attorney as well.
  • Go to every scheduled appointment! If you miss any appointments, the insurance company can terminate temporary disability. If you have missed two consecutive appointments, they could refuse to pay for further treatment.

More important than anything is making sure you have an attorney that has specific Workers’ Compensation experience. Lawyers who have worked in this field extensively know which doctors are likely to be the least independent in their assessment of your injury and they can help you prepare for a productive doctor’s visit that won’t hurt your case. Most Workers’ Compensation attorneys (myself included) will evaluate your case for free; all it takes is a call. If you have been hurt and want someone to fight for you, call me at 303-792-5595, or submit a request by clicking the button on the right side of the page to have someone from our office contact you.

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