Do I have to be examined by the workers’ comp doctor to get my benefits?

If your employer’s insurance carrier has recommended you see a doctor, then you probably do need to see that doctor in order to get benefits. It’s unlikely they think you need further (or different) medical care—chances are that the insurance company is contesting some part of your claim. The examination being recommended is likely called an “independent medical exam,” or IME, though the exact names used for the exam and even for the doctor may vary based on the state you’re in.

Different Names – Same Doctor

In California, for instance, the doctor involved in your IME may be called a medical evaluator. In other states, the doctor is usually called an independent medical examiner. There may be other names used for the examining doctor as well. Just remember that they all refer to the same person—the medical professional tasked with examining you, evaluating your injury, and creating a written report regarding the cause of your injury.

Preserving Your Interests During the Exam

Make notes right after the exam about how long the exam took, what the doctor asked you, what the doctor told you to do, how the doctor examined you and whether or not any diagnostic tests were taken (if they were, what kind). You may even be able to bring an unpaid observer to the exam. Check with your workers comp advocate or liaison. All of these steps are intended to ensure that the process goes as smoothly and painlessly as possible. Remember, the point of the exam is the determination of your injury as work-related.

Getting Legal Help

Some of the medical doctors who perform these evaluations or examinations may be more sympathetic to workers – some to employers. The law encourages the parties to mutually agree upon a doctor to do the evaluation. Whether you are represented by an attorney will also affect this process. That’s why it is a good idea to consult a lawyer before attending one of these required exams. Experienced workers’ comp attorneys are familiar with many of these doctors and can steer you in the right direction when choosing a doctor on the insurer’s list.

Case Studies: The Role of Independent Medical Exams in Claims and Coverage

Case Study 1: Insurance Coverage and Independent Medical Exams

Mark, an employee who suffered a work-related injury, filed a workers’ compensation claim. His employer’s insurance carrier recommended that Mark undergo an independent medical exam (IME) to assess the extent of his injury and determine the cause.

Mark was initially hesitant about the IME and its potential impact on his claim. However, after consulting with his attorney, he realized that the insurance company’s request for an IME was a standard procedure to verify the validity of his claim.

The IME report played a crucial role in determining the insurance coverage Mark would receive. As a result, he decided to cooperate and attended the IME, providing accurate information to ensure fair assessment and appropriate coverage.

Case Study 2: Legal Representation and Insurance Claim Evaluation

Sarah, an employee who suffered a workplace injury, sought legal representation for her workers’ compensation claim. Sarah’s attorney advised her on the importance of thorough documentation and the potential impact it could have on her insurance claim.

Understanding the significance of accurate records, Sarah diligently maintained a detailed log of her medical treatments, doctor visits, and any other relevant information. When the insurance company requested an independent medical exam, Sarah’s attorney accompanied her to ensure the process was conducted fairly.

Thanks to the comprehensive documentation and legal representation, Sarah’s insurance claim was evaluated accurately, leading to appropriate coverage for her injury-related expenses.

Case Study 3: Challenging Insurance Denial Through Independent Medical Exam

Michael, an employee who suffered a workplace injury, faced a denial of his workers’ compensation claim by the insurance company. Unwilling to accept the denial, Michael sought legal advice to explore his options.

His attorney recommended requesting an independent medical exam to challenge the denial and gather objective medical evidence supporting his claim. Michael underwent the independent medical exam, ensuring he provided a complete and accurate account of his injury and its impact on his ability to work.

The resulting IME report provided a fresh perspective, revealing the work-related nature of his injury and compelling the insurance company to reconsider their denial. As a result, Michael was granted the insurance coverage he deserved.