How does an independent medical exam affect a workers' comp claim? Can you get a second opinion if you feel the diagnosis is biased or incomplete?

In workers’ compensation cases, your employer has the right to request an independent medical examination to verify the severity, treatment, and limitations of your workplace injury. However, you employer’s purpose of this request may be more than just verification.

How an Independent Medical Exam Impacts Your Claim

When an employer disagrees with your physician’s assessment of your injuries, an independent medical examiner (IME) may be appointed to provide a second opinion. However, since IMEs are specially certified to judge workplace injuries, they’re often viewed as experts. What does this mean for your case? It often means the IME's findings supersede your doctor’s assessment. Furthermore, since they aren't involved in your treatment, IMEs are considered more objective than your personal physician, although that's not always the case.

IMEs tend to empathize with employers. As a result, they might understate injuries and report that the worker could continue working despite the pain. Since the IME’s report is used to determine workers' comp benefits, his professional bias could result in:

• Decreased recovery time. If the IME says you can go back to work in a few days, your employer will stop paying your lost wages after a week, despite the fact that you may not be well enough to return.

• Less treatment. If the IME reports that at-home exercises would be efficient, your employer isn't obligated to pay for professional physical therapy costs, even if you need them.

• Reduced settlement. If the IME completely downplays your injuries, your employer may use the report to significantly reduce your compensation or even deny it completely on the grounds that your injury is too minor to qualify for benefits.

Contesting The Report

Fortunately, there are some situations where challenging the IME's report can be productive. These include when the report was:

• Conducted without a complete medical history. If the doctor’s report is based on insufficient data or incorrect information about your medical history, you should make that clear right away and challenge his findings.

• Inclusive of opinions outside the IME's area of expertise. According to the Florida workers’ compensation statutes: "An independent medical examiner may not render an opinion outside his area of expertise, as demonstrated by licensure and applicable practice parameters."

• Filed late. The findings of the IME must be admitted within 15 days of the examination. When filed past this timeframe, the findings will not be admissible as evidence before a court or judge.

• Significantly different than the initial physician’s report. If there's a glaring discrepancy in assessment of injury severity or recommended treatment, the dispute can be resolved by a mutual consensus—by all parties—employee, employer, insurance company—for a third opinion. This opinion shall be represented by another independent physician who specializes in the diagnosis and treatment of the specific injury in question. If all parties agree to the referral of the third report, that report will be considered binding, and no other challenge can be made.

When an independent medical exam is used to limit or deny your workers’ compensation benefits, an experienced workers' comp attorney can help you fight back. Protect your interests by calling the law offices of Johnson & Gilbert, P.A. at (386) 673-4412 today!

We can help you file objections, schedule a deposition to question the doctor, and request another examination, if needed. Don’t allow your employer’s tactics to keep you from your legal benefits. Schedule your free consultation today.