Independent Medical Examinations

Independent Medical Examinations in Workers Compensation

Posted on Posted in Blog

Pursuant to Florida Statute section 440.13(1)(k), independent medical examinations (“IME”) are “an objective evaluation of an injured worker’s medical condition, including, but not limited to, impairment or work status, performed by a physician or an expert medical advisor at the request of a party, a judge of compensation claims, or the division to assist in the resolution of a dispute arising under this chapter.” The Workers Compensation law allows both the carrier and injured employee the right to an IME. The main reason why an IME may be needed is if there is an issue or dispute in the Workers Compensation claim. An issue generally arises if the injured worker is seeking a benefit, but the Employer/Carrier denies that benefit. Further, the only condition that is required to request an IME is if a dispute of some sort has arisen in the claim.

One of the most common scenarios that an IME may be required is when the Employer/Carrier denies a claim based on major contributing cause. In this case, the Employer/Carrier’s position is that the claim should be denied because 51% or more of the cause of the employee’s symptoms are due to some type of pre-existing condition. Many times the Employer/Carrier may accept a claim as compensable and provide medical treatment through Workers Compensation, however the authorized physician may opine that the major contributing cause of the injured worker’s symptoms are not the work accident. The Employer/Carrier then denies the claim on the basis of this physician’s opinion. As such, this becomes an issue in the claim. The injured worker is then entitled to select a physician as an IME in order to have that physician give his or her opinion about the major contributing cause. If the claimant’s IME then opines that the major contributing cause of the symptoms are related to the work accident, then an expert medical advisor may be required to resolve the dispute between the authorized physician and the IME.

Another common scenario in which an IME may be required is if an authorized physician recommends a surgical procedure, but the Employer/Carrier seeks the opinion of an IME to determine whether the major contributing cause for the surgical recommendation is the work accident. The Employer/Carrier then selects an IME physician to examine the injured employee. If the IME physician does not believe the major contributing cause for the surgery is the work accident, then once again an expert may be required to resolve the dispute.

Independent medical examinations are generally one time evaluations that are conducted by a physician. The party requesting the examination is usually responsible for costs of the IME, which also includes the physician’s fees and costs for any diagnostic testing. One situation that an injured worker would not have to pay for an IME is if the carrier is part of a managed care system. These days, there are not many carriers that participate in managed care systems, but there are some that still do exist.

As you can see, independent medical examinations are an important part of the Workers Compensation system, but they can only be used in certain situations. That is why it is important to hire a Workers Compensation attorney who handles these types of situations. If you were injured on the job or know of someone who was, have them give us a call at (844) 762-8155.