Posted on: 26 May 2016Share
The independent medical examination plays a major role in whether or not your workers' compensation claim will be approved. If the examiner does not agree that you are medically unable to work, your claim could be denied. If you have an examination scheduled, here is what you need to know.
Can You Refuse the Exam?
You are legally required to undergo an examination with an independent medical examiner, or IME, if requested by the insurance company. The company will choose the doctor who conducts the exam.
If you refuse to go to the exam, the insurance company could refuse to pay your workers' comp claim. The company could argue that your unwillingness to be examined by the IME is an indication that you are not seriously injured enough to be off work.
How Can You Prepare?
Although the IME is allegedly unbiased, you have to remember that he or she was chosen by the insurance company. Any inconsistencies between the reports you have given to the insurance company and the IME could lead to your claim being denied.
Prior to the examination, you need to prepare for questions that will be asked by the IME. It is also possible that the insurance company might contact you to conduct a phone interview regarding your injuries. You need to tell the same story to both the claims examiner and the IME.
To ensure your story remains consistent, write down what happened and the injuries you suffered. Writing it out will help you to remember the sequence of events. You also can refer to the written testimony during your interview and examination.
In addition to this, you need to schedule an appointment with your own doctor. If possible, see your doctor on the same day as the IME. Your doctor can write his or her own report regarding your injuries. If your claim is denied, your doctor's testimony about your injuries could help with an appeal.
What If You Do Not Agree With the Report?
The IME's report will be forwarded to the insurance company and a determination regarding your claim will be made. You have a right to the report. Contact the insurance company and request a copy.
If you do not agree with it, your attorney can ask your state's Department of Labor to authorize another examination with a different doctor. Depending on the state in which you live, you might be able to choose the IME for the examination.
You also need to file a formal appeal with your employer's insurance company. There is a statute of limitations that applies to the appeals process, so file your appeal as soon as possible. If you need any help during the process, speak with a law firm like Freedman, Wagner, Tabakman & Weiss.