When you file a workers’ compensation claim in Arizona, your employer’s insurance company may want to schedule you for an independent medical examination, also known as an IME. This is typically when the insurer needs more information about your work-related injury or medical condition before accepting or denying your claim.

An IME also safeguards the insurer if it believes that your personal treating doctor may be too biased in your favor. Theoretically, an IME offers the insurer a chance to have an objective second medical opinion to ensure that your treating physician’s medical opinions, diagnoses, and treatment recommendations are what you really need.

However, you might discover that the examiner can turn your IME into a more challenging encounter. If you believe your IME doctor has performed your IME in a way that is unfavorable to you, contact the Matt Fendon Law Group at (800) 229-3880. We can help you understand the IME process, including any IME doctor tricks you might encounter and what you can do about them.

When is an IME Needed to Process My Workers’ Comp Claim?

An IME is not always required when claiming workers’ compensation benefits.

However, they are common enough that you should be prepared if the workers’ comp insurance carrier requests one. It is helpful to know what to expect, how to prepare, how to conduct yourself during the exam, and what to do afterward if you believe the examining doctor did not treat you fairly.

You can expect to be scheduled for an independent medical exam if any of the following apply to you:

• The insurance company disagrees with your personal doctor’s medical opinion about your injury or condition
• Your workplace injury claim is threatening to become too expensive for the insurer
• The insurer needs more evidence to resolve a dispute about your claim, to limit or deny your claim.

If your treating physician determines that you have a total or permanent disability, you count on the insurance company sending you for an independent medical exam with a handpicked IME doctor.

What Happens During an IME?

An IME doctor’s primary goals are to:

• Gather more information about you
• Understand your work-related injury or condition
• Document your current symptoms
• Understand the treatment you have been receiving for it and the results of that treatment
• Discover any medical preconditions you may have that could affect your workers’ compensation claim

You must attend all medical exams that the insurer schedules for you. If you fail to show up, the IME might result in a denial or delay of your workers’ compensation claims.

The IME doctor will share the results of the IME with the workers’ comp insurer, which will use that information to decide whether to approve your claim.

What Can Go Wrong in an IME?

Why do some IME doctors use misleading tactics in IMEs? The workers’ compensation insurance company is not your friend. When it comes to making a profit in its business, the insurer’s interests can be inconsistent with your interest in receiving the best possible medical treatment you need in the aftermath of a work-related accident.

This can translate into the workers’ comp insurance company allying itself with IME doctors who will focus mainly on helping the insurer keep costs down. Your claim is a potential cost.

What Tactics Can IME Doctors Use During an IME?

As mentioned above, an IME doctor might be motivated to help the insurance company keep the costs of your workers’ comp claim low. Here are some tactics that IME doctors use to accomplish this objective.

Downgrading Your Treatment

Medical treatment for a work injury or illness can be expensive, especially if the optimum treatment plan requires surgery or ongoing treatment like rehabilitative, physical, or vocational therapy. One way that an IME doctor can save the insurer money is to recommend medication-based treatment instead, like prescription painkillers.

These pill-based treatments may lessen your symptoms but ultimately prove to be less effective in helping you to recover fully.

Casting Doubt on Your Claim

If the insurer can conclude that your injury or condition is not as serious as you believe, it is easier to challenge or deny your workers’ compensation claim.

Sometimes, an IME doctor might look for reasons to conclude that you are a “malingerer” or are even engaging in claim fraud. This can mean trying to catch you in an inconsistency, like engaging in activities you should be unable to do (for example, engaging in heavy lifting when you claim to have a back problem or having a “selective limp” depending on whether you think someone is watching).

Not Being Thorough in Evaluating Your Claim

Most IME doctors are paid based on the number of workers’ comp claimants they see rather than on how long they spend with any given one. This can incentivize an IME doctor to spend as little time with you as possible to make room for more independent medical exams per day.

Also, the IME doctor may refer you to a healthcare provider or product manufacturer that might not be best suited for your needs but with which the doctor has a financial interest. This can lead to unnecessary or incorrect treatment, such as requiring you to undergo unnecessary tests.

In a worst-case situation, the workers’ comp insurer might conclude that these “extra” services are not medically necessary for your treatment and refuse to pay for them. That would leave you on the hook for the costs.

How to Prepare for an IME

You have no control over who the insurance company selects as your IME doctor. However, you can improve your chances of receiving a fair IME if you are ready for the exam and savvy about what the IME doctor will be looking for.

Here are some proactive steps you can take ahead of your IME:

• Prepare yourself in advance by reviewing your notes and relevant medical records. Before the IME, write down notes about your injuries, symptoms, treatments, and how the work-related accident or conditions made them happen. This can help keep your recollection sharp and reduce the risk of saying something that might be held against you during the exam.
• Learn what the insurance company has communicated to the IME Doctor. Often, the insurance company communicates with the IME doctor in writing. If possible, request a copy of this communication to ensure it does not misstate the nature of your claim or treatment.
• Dress appropriately for the occasion. Depending on the nature of your injury or condition, you might require medical devices like a brace, crutches, a sling, or dark glasses. If you attend the IME without these items, your IME doctor may take note of that as being inconsistent with your claimed injury.
• Give yourself enough time to be on time. Missing your IME appointment or being late can harm your credibility with the IME doctor.
• Talk with your workers’ comp claim lawyer. If you have been scheduled for an IME, talking with your workers’ comp lawyer is a good idea. Your lawyer can help you review what you must do during the IME and ensure you understand your rights and options if the IME doctor makes an unfavorable report.

What You Can Do During Your IME

During your IME and its physical examination, there are several steps you can take to make the process go more smoothly.

• Be aware of your situation. Unlike an appointment with your doctor, you have no doctor-patient relationship with an IME physician and no right to confidentiality. Assume that the IME doctor will report everything you say and do to the workers’ comp insurance company, and that information can be used against you by the insurer.
• Bring a witness with you. You are allowed to bring a friend or family member with you to your IME. Although this person cannot speak to you or the IME doctor during the meeting, this person can observe and take notes. These can be helpful later if a disagreement arises about what was done or said between you and the IME doctor during the IME.
• Record the exam. It is permissible for you to make an audio recording of your IME. Doing so can encourage the IME doctor to be more thorough during the exam. It can also create evidence to counter the doctor’s report or other testimony by preserving improper conduct during the exam. However, let the examiner know you will be recording audio.
• Be cooperative with the IME doctor. Even if you believe the IME doctor is not being fair to you, resist the temptation to be confrontational or defensive. This includes giving your best efforts when the IME doctor asks you to perform range-of-motion and other physical tests. If you give the doctor any reason to suspect that you are not giving your best effort, the IME doctor might use such behavior against you when writing the report for the insurer.
• Be honest and forthright about your symptoms. Stoicism during your IME does not mean that your IME doctor will respect you more. If you are experiencing pain symptoms, mention them. It is better to bring them up to become part of the IME record than to suffer them in silence.
• Report any improper conduct by the IME doctor or the case manager nurse. You are entitled to dignity, courtesy, and respect in your exam. If you believe you have been treated poorly by the IME doctor, your workers’ compensation claim attorney can help you report that in writing to the Industrial Commission of Arizona.
• Distinguish any prior injuries or conditions you may have. If you have suffered any prior accidents, medical conditions, or past work-related injuries, tell the IME doctor about them if he or she asks.

What Can You Do After the IME?

After the IME is over, the IME doctor will prepare a report. You or your workers’ comp claim attorney should receive a copy of this report.

Make sure to read the report carefully. If you see any errors in it or factual mistakes about your medical history or treatment, make sure your lawyer knows about them.

If you don’t already have an attorney for your workers’ comp claim, now would be a good time to consult an experienced worker’s comp attorney.

Getting a Second Medical Opinion

If you believe that your IME doctor did not conduct a thorough or fair IME or that the IME did not correctly address your medical issues, your workers’ comp lawyer may be able to request another IME with a different doctor. Your attorney may also be able to file objections or conduct a deposition of the IME doctor if necessary.

Most insurance companies permit an injured worker to have a second evaluation. The second IME will also be by an IME doctor of the insurer’s choice, so you will still need to remember everything you have learned about preparing for and attending the second IME.

Lastly, after you file your workers’ comp claim, you can undergo an evaluation and treatment from a physician of your choice.

How to Protect Your Workers’ Comp Claim

If you are satisfied with how the IME doctor conducted your IME, you do not need to do anything more while you await the insurer’s decision on your claim.

However, if you believe that the workers’ comp insurance company is not treating your claim with the seriousness it deserves or aren’t sure you’re getting the benefits you need, don’t wait to protect your claim. Talk to a workers’ compensation attorney.

Consult with a Phoenix Workers’ Compensation Lawyer About Your IME

At the Matt Fendon Law Group, our highly skilled and compassionate workers’ compensation lawyers are ready to help you through the entire process of your workers’ compensation claim, including but not limited to independent medical examinations. 

We can help you:

• Understand what is happening with your workers’ compensation case. The process of obtaining workers’ compensation benefits can be stressful and complicated. It’s critical that you have an experienced Arizona workers’ comp lawyer on your side.
• Deal with your employer and its insurer. Employers often try to intimidate or take advantage of injured workers, and insurance carriers can be tempted to stonewall your claim. The attorneys at Matt Fendon Law Group will stand up for your rights.
• Receive the workers comp benefits you deserve. While you recover from your work injury, workers’ compensation benefits pay a portion of your lost wages and medical care. 
• Handle your appeal. If your workers’ compensation claim is denied, our experienced workers’ compensation lawyers can help you assemble the strongest argument on your behalf within the tight 90-day appeal deadline.

Call us at (800) 229-3880 or reach out online to speak to an attorney about your IME today.