What Is An Independent Medical Examination (IME)?
An IME is a medical evaluation to determine the status of a worker’s medical condition. The IME doctors answer questions, written by claims managers. The questions look like this:
- Is any further medical treatment necessary?
- Has the worker’s claim-related medical condition reached maximum medical improvement?
- Are there work restrictions?
- Is there any permanent impairment?
Who Requests an IME?
- Labor & Industries. (this is a problem)
- Self-Insured employers. (this is a problem)
- Your doctor (this could be a problem)
- IME’s are a problem
Why Is an IME Being Scheduled?
IME’s are usually scheduled by L&I and Self-Insured employers because they want to:
- gather information
- segregate out medical conditions
- deny medical conditions
- end medical care
- close your claim
Claims managers move your claim in the direction they want it to go by scheduling an IME with doctors who will help them “manage” a claim. These IME opinions allow them to have their way with your L&I claim.
When Can an IME be Requested?
- To make a decision regarding claim allowance or reopening.
- To resolve a new medical issue, an appeal, or case progress.
- To evaluate a worker’s permanent disability or work restriction
- There are rules about IME’s in the Washington State statutes
Can I Dispute the Scheduling of an IME?
- RCW 51.36.070 You can dispute the scheduling of an IME. The number, frequency, timing and the reason for IME’s can be questioned through the dispute process.
Questions? Email: [email protected]
The Truth About IME’s
IME’s are what claims mangers use to deny medical care. They use IME’s to close claims. IME’s are designed and administered to ruin your L&I claim.
IME’s are a complete sham. IME stands for Independent Medical Evaluation. However they are not independent and they are not a medical exam. They are a bought and paid for one sided records review with an opinion likely to do harm to your claim.
The Harsh Reality of Serious L&I Injuries
Serious job injuries are human tragedy. For many serious injuries there is no good solution. There is no complete recovery from the unrelenting pain and permanent disability. The L&I claim has to end somehow. So L&I uses the IME to make that happen and to pound nails into the coffin of the injured worker’s claim.
Don’t like what L&I is doing to you? Then do something about it.
It is the responsibility of the injured worker to salvage what they can from the L&I claim. Let me say it again.
IT IS THE RESPONSIBILITY OF THE INJURED WORKER TO SALVAGE WHAT THEY CAN FROM THE L&I CLAIM.
Do not confuse politeness with your responsibility to take care of yourself. If you don’t help yourself, who will do it for you? If you can’t help yourself then see if a lawyer will help you. You only get a short period of time to salvage what you can from your L&I claim. Do it or lose it!
Be Prepared When you Attend Your IME
- Bring in an observer – This can be a friend or a relative. Your friend or relative can attend your medical exam, but not your psychiatric exam. An observer can be helpful.
- Understand what the IME is. The purpose of the examination, is to shut down your medical treatment and your L&I claim.
- An IME doctor is not your doctor. The evaluation does not create a doctor patient relationship. The IME doctor will not prescribe medication and will not treat you.
- This doctor may try and trick or confuse you with his tests. Give genuine effort and honestly communicate your pain levels and limits. Do not exaggerated your pain levels.
- What to wear. Avoid clothing that restricts movement. Avoid clothing and accessories that can convey negative non-verbal messages.
- Know about your treatment plan. Be knowledgeable about the doctors you have treated and consulted with, what kinds of medication you are currently taking and what kinds of regimens and home therapy programs you are completing. With your doctor’s permission avoid taking medication that would cause drowsiness or limit your ability to focus at the appointment, avoid medications that reduce inflammation or mask pain. Your want the IME doctor to be able to see your pain and swelling without you needing to show it to him.
- Your medical records will be a big part of the IME. Know what is in them.
- Don’t volunteer information. Don’t offer opinions. Don’t overly compliment the doctor.
- Don’t be offended by the doctors questions unless they are totally inappropriate. It’s their job to get personal about your injury.
What Happens at the Examination?
- The IME doctors spends lots of time with your medical records and only a little time examining you.
- The physicians will take your medical and family history, ask about current symptoms, and perform a short physical examination with testing. Rarely do they request x-rays or lab tests. They will write a report for L&I or the self insured employer with their findings and their opinions.
- The IME doctors perform a one time exam and they should focus only on industrially related conditions. These physicians are not your doctor! These IME doctors are paid by L&I and self-insured employers to produce a report with results that please L&I or the self insured. These examinations are not designed to assist injured workers with their claims! Be careful!
- Some of the physicians actually watch you from the minute you leave your car until you return to your car and drive away. It is not uncommon to see IME reports which say things like “he ran from his car to the office, but began to limp when he entered the exam room”. Don’t allow something like that to happen to you.
- Independent Medical Examination doctors can be tricky so keep the following in mind:
- Light touch to any area should not hurt. If you act like it hurts they will report you as a faker.
- Do not exaggerate your injuries. Many IME doctors want you to exaggerate your injuries so they can say that in their report.
- The distraction test involves pretending to test one area, while recreating a previous test to a different area. For example, if the doctor is testing your neck he might do so obviously in front of you. Later he might test it via distraction by asking you questions while he walks behind you. He is looking to see how you rotate your neck when you don’t realize your neck is being tested.
- Dropping an object such as a pen on the floor is used to see if you will either pick it up or look at it quickly and thereby make movements that you would not have made while you think you are being tested.
Can I Bring an Observer to the IME?
Yes you can. If the IME doctors tell you different they are wrong. Here are the details:
- An observer can be a friend or relative, but not your attorney, paralegal, or doctor.
- The observer can attend the physical examination but not the psychiatric examination. WAC 296-20-2025
- This observer can see and take note of anything the IME doctors do which may not be appropriate. They can also keep track of how much time was spent examining you versus how much time was spent reading your records.
- An observer can help keep the IME doctor honest. It’s a good idea to bring someone along.
Will I Get Reimbursed for Missing Work and for Mileage?
- Missing Work – Yes, you should be reimbursed based on your hourly wage at the time of the examination RCW 51.32.110 (4). Talk to your claims manager to make this happen.
- Mileage – Yes! In certain situations there is reimbursement for meals, hotel expenses, taxi fare, parking costs, and ferry and bridge tolls. RCW 51.32.110 (3), WAC 296-20-1103 and L&I Claim Adjudication Guidelines. These will be paid at the current department rate. Note also that Insurer requested IME’s are not subject to the 15 mile deductions. SAVE YOUR RECEIPTS!!! You must complete a travel reimbursement form within one year of the exam and include your receipts. Travel reimbursement form.
- If you have a physical or mental disability, additional travel arrangements can be made to assist in your traveling to the exam.
What If I Need to Reschedule?
- Contact your claims adjuster immediately and request a different date. Reasonable requests should be accommodated.
What Is In an IME Report?
An IME report is a medical record used to manage your claim.
The IME doctor uses lots of ink reviewing and writing about your medical records. They then spend a few minutes with you, and churn out a report with its prepared conclusions.
IME report conclusions are often written before you even walk into the IME. That “doctor” was simply waiting to fill in your name. These conclusionary statements are already sitting on the word processor of the IME doctor.
These guys get paid by the page. As a result they will write many pages about the history of your claim. In effect this is simply reading and reproducing the existing medical records so they can charge more money.
Here are some of their pre-written conclusions.
- The injured workers medical condition has reached maximum medical improvement
- No more medical care is needed
- The medical condition was a pre-existing condition
- The worker has returned to pre-existing status
- The injured worker can return to the job of injury without restrictions
- There is no permanent partial disability related to the industrial injury
- There is no depression, the injured worker has a personality disorder
What Happens After an IME?
Your claim will change after an Independent Medical Examination
- The exam is converted into a report. That report is now called the IME.
- The IME goes to L&I or the Self Insured Employer.
- They usually send a copy to your doctor with a cover letter to your doctor asking them to agree or disagree with the IME report.
- Doctor if you agree, initial here ____
- Doctor if you disagree, write a lengthy report.
This is a problem. The doctor can initial in 5 seconds and be done. OR the doctor can spend an hour or more pointing out where and how another doctor is wrong. It’s too easy for your doctor become part of the problem when they agree with the IME.
L&I or the Self Insurer take the IME and your doctor’s concurrence and move your claim in the direction of the IME’s conclusions. For example when the question to the IME examiner was: Is the claimant fixed and stable? And the answer is yes fixed and stable. Then L&I will move to close the claim.
An order is issued by L&I or self insured employer, closing the claim.
You have 60 days from receipt of this order to protest or appeal. Do it or lose out. How To Disagree With An L&I Decision
What Can I Do About a Bad IME?
This is important. This is how you can help yourself.
- Your attending physician will be asked to agree with the IME. If it is a bad IME, and he agrees then you have a big problem.
- If your attending physician disagrees with a bad IME then there is still hope for your claim. Talk with your doctor before he agrees with a bad IME . Get your doctor to write a helpful report which disagrees with the incorrect IME findings and conclusions. Have your doctor include their own findings and conclusions. It will make a difference.
Settlement After an IME
An IME often effectuates claim closure. At claim closure L&I will often address the subject of claim settlement with a permanent partial disability (PPD) award. There are several types of settlements. Learn about them and get one for your claim. What is a L&I Settlement
Who Are These IME Doctors?
A few of them are real doctors. Many of these guys are washed up losers. They have long ago sold out to the establishment. They are non believers. Before you even walk into the IME some of them already believe you are not injured. Some of these guys do IME exams because they do not have the personality nor the disposition to care for people. They are not treating doctors. The have sold their soul and now they do the devils work. They are bought and paid for by L&I and Self Insureds. Some of these IME doctors make hundreds of thousands of dollars a year sticking it to injured workers.
How to Complain About My IME
Minor Complaints, such as rudeness can be handled by L&I. Send a complaint letter or a completed IME comment form to:
IME Provider Review – L&I
PO Box 44322
Olympia, WA 98504-4322
For Serious Violations – of State Law RCW 18.130 including unprofessional conduct, fraud, and misdiagnosis of a condition contact the people who license them Washington State Department of Health. If you don’t do it who will?
- Physician Complaint Form
- Nurse Complaint Form
- Health Facility Complaint Process
- Department of Health FAQ regarding Medical Complaints
IME’s are Serious Business
IME’s are designed to put an end to your time loss and medical care. They are set up to close your claim with no settlement or less settlement money than you deserve. Are you going to let them do this to you?
You can either do nothing to correct a bad IME or you can do something. It is your choice. I suggest you do something to help yourself.
Chris Sharpe is a Seattle, Washington workers’ compensation attorney that has helped hundreds of injured Washington State workers. Chris’s firm represents only individuals who have been injured or are disabled, never the employer or insurance company. Learn more about the firm or contact us today to see how we can help.