The problem with “independent” medical exams

On Behalf of | Mar 8, 2017 | Workers' Compensation

In New York, injured workers may choose their own treating physicians – in fact, employers can face criminal action if they interfere with this right. However, employers and insurance companies have an opportunity to undermine the doctor’s opinion and damage the workers’ claim for damages: the independent medical exam, or IME.

After you’ve seen your own doctor, the insurance company may then require an IME, an “ostensibly neutral exam by a doctor they select and pay for.” The last part of that definition may send up red flags, as it should – if the doctor is chosen and compensated by one party, can they truly be neutral?

According to the New York-based Center for Justice & Democracy, the answer is no. The group created a fact sheet detailing some of the many problems with the IME system, including:

  1. IMEs have anti-worker bias: Because IME doctors are essentially employer by insurance companies, they have a vested interest in keeping insurers happy – which they often do by minimizing the severity of worker injuries. One IME doctor admitted to the New York Times, “If you did a truly pure report, you’d be out on your ears and the insurers wouldn’t pay for it… That’s the game, baby.”
  2. IME doctors aren’t always competent: IME doctors are not required to go through any special training on work-related injuries. Many of these doctors have semiretired from the frequent practice of medicine, meaning they may not be keeping up on the latest medical developments.
  3. IMEs aren’t always thorough: Time is money, and sometimes IMEs last only a few minutes – not long enough for the doctor to truly examine the injury and make a diagnosis. In extreme cases, IME reports have been filed when the doctor never met with the patient at all.
  4. IME doctors’ opinions have real consequences: Insurance companies may use an unfavorable IME report to cut a workers’ benefits, deny a claim or stall the process – all of which may pressure the worker into taking a lowball offer.

If you are asked to submit to an IME — or if your employer or its insurer gives any indication that your benefits may be decreased or denied – it is wise to speak with an attorney right away.