Introduction
Oregon Workers’ Compensation is a private insurance benefit system. Private insurance companies review and decide your claim, and only if there is a dispute does the State of Oregon Workers’ Compensation Division or Board get involved.
When a claim is filed, the insurer will often request that “independent” medical examination, also called an “IME.”. These examinations are conducted by physicians who have vast experience providing opinions, and although some are fair, many are not (in our experience and opinion)
What is an IME?
An IME is an appointment when the insurance company hires one or more doctors to examine you and report findings back to the claims adjuster. It may be used to investigate your workers’ compensation claim.
Here are some things we tell our clients who are headed to an IME.
It’s Required
Your attendance at the IME is required. If you do not attend the IME, any current and future workers' compensation benefits may be suspended until you attend a rescheduled appointment.
It’s Not Medical Care
The IME doctor is not going to treat your condition. IME consultants are hired by the insurance company in the hope they will prepare reports which will support the insurer's interest in minimizing compensation paid on the claim.
You Are In The Spotlight
The IME begins the moment you reach the doctor's office. Keep in mind the IME doctor may be observing how you move from that moment! Here are several other tips which may help you:
- Be on time, dress neatly, and be polite. Remember, IME doctors are not there to help you
- Do not have any alcohol or illegal drugs on your person, in your bloodstream, or in your urine.
- Do not exaggerate or understate your description of your original injury and the development of your symptoms. The insurance doctor will have your previous medical records and will compare what you report during your IME with what you've told other doctors during your treatment.
- Be completely honest with the insurance doctor. The doctor may be aware of insurance surveillance and other investigation, including reports by neighbors, co-workers and relatives, and he may have access to records of your overall medical history.
- You need not submit to any tests involving an injection. If the insurance doctor wants to administer an injection or perform some other test in which your body would be entered by a needle, tube, scope or scalpel, he must obtain your formal consent by asking you to sign a specific form.
- You should not sign any documents which may in any way limit or excuse the doctor's liability for any injuries that may occur during the examinations. If injuries requiring specific treatment occur in connection with the examinations, please let me know.
- Keep in mind the insurance doctor may make an audiotape or videotape record of the examinations. This recording of your statements may then form the basis for the doctor’s report on the development of your condition. If the examinations are recorded by videotape, audiotape, or by some other mechanical means, please let me know as soon as possible, so I may request a copy of the recording.
You Get Reimbursed for Travel
Remember the insurance company must reimburse you for your mileage, as well as other reasonable expenses associated with the use of a car or public transportation, and meals, child care costs and other expenses you may incur to attend the IME.
Reimbursement for Income Lost
If your claim has not yet been decided, and you are unable to work, you are probably receiving wage replacement benefits, also known as interim temporary total disability.
If you are not currently receiving time loss benefits, the insurer must also reimburse you in an amount equivalent to your net lost wages for time you miss from any work to attend the appointment. Keep receipts of all expenses and time records demonstrating any lost wages; make photocopies of your records; then send your request for reimbursement along with your supporting records and receipts by certified mail to the insurance adjustor.
If you will need advance reimbursement of your anticipated expenses to attend these examinations, notify the insurer as soon as possible so that you can have advance payment for expenses. Some insurers will even hire a taxicab to get you to and from the appointment.
Your Doctor Will Get the Report
After you attend the examination, a copy of the report is provided to your physician. How your physician views the report will often decide the fate of your claim.
Questions?
If you have questions about your claim, contact us or check out other resources we offer on the web site
