Let’s say you got hurt on the job, and the workers’ compensation insurer is providing you medical treatment, and paying you income benefits. Everything is going well. Then, you get a letter in the mail notifying you that the insurance company is sending you to another doctor for something called an IME. The two questions that immediately come to mind are: What is an IME, and why are they sending me to another doctor?
IME is short for Independent Medical Examination. In Georgia, an insurance company has the right to send an injured employee for an IME whenever it is reasonable to do so. Generally, they are not sending you to another doctor to help you. Instead, it is usually to try to get an opinion that is more favorable to its position. It is all about the insurance company trying to save money. So, if you are receiving weekly benefits, they may want to get another doctor to say that you are able to go back to work. Or, maybe your treating doctor is recommending an expensive surgery, and the insurer is looking for an opinion saying that the surgery is not necessary.
If the insurer sets up the IME consistent with the requirements of Georgia law – 10 days written notice along with a check prepaying you for your mileage to and from the appointment – it is important that you attend the appointment. Failure to comply could put your weekly income benefits at risk. When you do attend the appointment, it is important that you are honest about your symptoms, your pain level, and your medical history.
If the insurer’s IME doctor gives a negative opinion, it doesn’t automatically mean that your checks are going to stop or that you won’t be able to get that surgery that has been recommended by your treating physician. The insurer may try to use the IME report to influence your treating physician to change his previous opinion. Or, they may just deny the surgery based on this second opinion. If that happens, your attorney can file a request for a hearing, and it will be up to a judge to determine which doctor’s opinion is controlling. Usually, the treating physician’s opinion is given more weight in court than a doctor handpicked by the insurer who saw you only once. However, that isn’t always the case.
Under certain circumstances, you also may be entitled to your own IME at the insurer’s expense with a doctor of your choice. This can only be done one time during the course of your case, and you will have to give the insurer the same 10 days written notice of the appointment that they have to give you when they set one up. Like the insurer’s IMEs, you can use your IME to try to get another opinion regarding issues like restrictions and the need for surgery. Following the IME, the doctor’s report can be sent to your treating doctor to see if he will agree, or it could be used as evidence at a hearing.
It is important to understand that IMEs are nothing to be afraid of. They are merely a tool used by the insurance companies, and by injured workers, to try to get another medical opinion which is more favorable than that of the treating physician.Learn more about Independent Medical Exams In Georgia.