If you have been involved in an accident at work or were severely injured on the job, chances are that your employer’s insurance company will cover your medical expenses required for your recovery. When an injury at work occurs, the place of employment’s insurance company may stipulate that a neutral physician conduct an independent medical examination (IME) to determine your level of impairment or disability due to the work accident and document all of the details regarding your injury.
Why Is an IME Necessary?
If a company questions a diagnosis or a decision for treatment made by a patient’s regular doctor, the employer’s insurance company or legal officials may request that an IME be performed. This is to check if any disparities between the two doctors’ assessments exist.
An IME must be performed by a doctor who does not have an existing medical relationship with the patient and can, therefore, feel free to make an objective determination about all of the facts without any preexisting prejudice.
There are variations in how each state requires IMEs to be performed. Some states pull randomly from a list of acceptable physicians while other states permit the insurance company to assign a doctor to perform the IME.
An important point to consider is that a third medical opinion may be requested if the claim continues to be contested on either side.
Check the IME for Accuracy
If you get an IME, make sure to check the report for accuracy. If the IME is missing important pertinent information about your health or about your injury, point it out immediately.
If the IME doctor’s conclusions are based on not having certain facts or medical records, an additional medical assessment may need to be performed. You may be asked to write down that information in a letter to the IME physician and give a copy of the letter to the insurance company or your manager at work. This will be filed as an addendum to the initial report.
Is My Medical Information Protected?
An IME is an independent medical examination for the purposes of determining and documenting injuries that occurred in the workplace and when there is a dispute regarding the amount of financial compensation being given to the employee. Therefore, all of the employee’s medical information and every opinion will be in the IME to provide background for the medical claim, and this is a gray area under the HIPAA privacy rules (Health Insurance Portability and Accountability Act).
Looking for an IME?
If you own or manage a company and are looking for a trusted medical practice that can perform IMEs, contact our knowledgeable medical team at Total Orthopaedic Care. We can provide an independent medical examination and assessment of the employee’s injury, including related causation, impairment, functionality, restrictions, disability, prognosis, and recommended treatment.
We will provide a comprehensive narrative report in the IME detailing all relevant information. Our medical team knows how important it is to provide timely and accurate information to the patient, employer, attorneys, and caseworkers involved in claims.