Recently, attorney Samuel Heacox was on the faculty at the 2023 Workers’ Compensation Institute. He presented during a plenary session called: “A Look Behind The Curtains: Inside an Orthopedic IME.”
During the presentation, Mr. Heacox posed as the injured worker undergoing an independent medical examination (“IME”). He then participated in a panel discussion with an orthopedic surgeon, workers’ compensation judge and two attorney moderators. The subject of the panel discussion was providing insight into IME’s, a standard defense tool, bringing hands-on experience in this complex aspect of workers’ compensation claims and their value in claims and litigation. The participants discussed various issues and problems that come with IME’s, particularly those litigated at trials.
Importance and Subject Matter of Independent Medical Examinations
The importance of IME’s and their role in the worker’s compensation process cannot be understated. Knowing how the examinations work and what type of information is provided to the physicians can help to challenge the unfavorable reports. IME’s commonly address the following issues relevant to a workers’ compensation claim: (1) whether an injury was sustained; (2) if so, the nature and extent of the injury; (3) whether the medical treatment an injured worker has received has been reasonable, necessary and causally related to the work injury; (4) whether the employee has attained maximum medical improvement (“MMI”); (5) whether the employee has sustained any permanent partial disability; (6) whether the employee requires any further medical treatment or work restrictions.
Possibility of Multiple IME’s
IME’s are not always “one and done.” Disputes with employers/insurers’ may require multiple IME’s to address different injuries/conditions. Additionally, IME’s can be repeated by the same doctor in the future if a reexamination is reasonable. The opinions set forth in an IME report often dictate an employer/insurer’s defense position and whether they will approve, deny or discontinue certain medical, indemnity and/or wage loss benefits. An unfavorable IME can result in, among other things, a denial of certain medical treatment, such as surgery, a dispute over vocational rehabilitation benefits, and an attempted discontinuance of wage loss benefits.