Do You Really Agree With That “Independent Medical Exam?”Posted by bcps.adminJune 8, 2010
Injured workers are frequently sent for an “independent medical exam” (“IME”), so the employer’s comp insurance carrier can get a second opinion. This common practice sounds fair and innocent enough. In fact, it is laden with landmines which can be fatal to the injured worker’s compensation claim. Most of the hazards lurk just behind the cover letter asking for the injured worker’s treating doctor’s concurrence with the IME doctor’s report.
Please consider carefully the effect of your concurrence.
By concurring with the IME report, you go on record as agreeing with everything in the IME report. Your concurrence means you are in total agreement with every point in that report. You are not just in general agreement. You do not just agree with the diagnosis. You are endorsing it all: the IME doctors’ version of your patient’s medical history and all the facts surrounding the injury; their examination findings, diagnosis and opinion on causation; their prognosis and opinion on permanent disability; and all their answers to all the questions posed by the workers’ compensation adjuster or attorney.
As treating physician, your opinion carries great weight because of your opportunity to see and treat the injured worker. When you concur with an IME report, your seal of approval gives that report the weight and authority of your opinion as treating physician.
Under workers’ compensation law, your opinion as treating physician is required for determining the extent of your patient’s disability, unless you endorse another doctor’s opinion. Your concurrence may result in your relinquishing your authority to doctors who have been hired by an insurance company for the purpose of questioning your authority.
This calls for a very careful reading of the IME report. The compensability of your patient’s work injury – including pay for time loss, past present and future medical bills and compensation for permanent injury – hangs in the balance.
This calls not only for a very careful reading of the IME report, but also for specific comments backed by cogent explanations for each and every point at which you disagree.
Your concurrence may result in your relinquishing your authority to doctors who have been hired by an insurance company.
Lengthy IME reports are not only a challenge for you to read, but also may convey to the judge that they are better (more extensively) explained and more thoroughly documented than your opinion. This does not mean you have to make an equally lengthy response. But your response should be at least explained and should show that your knowledge of the facts is at least as extensive and detailed.
In your response, you may refer to specific chart notes detailing your prior examinations and treatment. If you have not seen your patient since the IME report was written, you may want to see your patient again to insure your knowledge is as complete and current as that of the IME doctors.
If you do not understand the significance of some of the questions posed to the IME doctors, it is always a good idea to consult with your patient’s legal counsel. If you need more time to do the job justice, call the person who sent you the report and ask for it.
Thoroughly and carefully reading and responding to an IME report before sending your response may save you time later and avoid misunderstandings potentially fatal to your patient’s injury claim. Your concurrence is not easy to undo. If you concur with the IME report and later realize you didn’t agree with some parts, those reviewing your patient’s claim will scrutinize your “change of opinion” very carefully. They will demand a convincing explanation. Anything less than a very careful and thorough reading before your response may put you in an awkward position and put your patient’s claim in jeopardy.
Therefore, if anything whatsoever in the IME report does not represent your perception of your patient’s condition and injury, and/or if any opinion is not your opinion, make that clear in your response.
Please answer all the questions that the IME doctors were asked to answer. If your answers do not match theirs, send in your answers, restating each question or at least referring to it by number.
Most importantly, again, explain your disagreement and back your explanation with specifics gained from your examinations, treatment and discussions with your patient. Obtain more information from or an additional examination of your patient as needed.
This article was prepared by Robert F. Webber.
The Importance of an IME Cover Letter
Posted by Weber Gallagher on 01.13.2017 in Uncategorized
The independent medical evaluation (IME) is an important part of the management of a workers’ compensation claim, whether the claim is in litigation or not. Once you have selected your medical expert, you need to determine what information you need to provide to your expert, and what issues you want addressed by the expert. Hence, an IME cover letter is significant. The first part of the cover letter should introduce the doctor to the employee, and provide a reason for why you are seeking the IME. Is this a denied claim in which you are seeking a medical opinion as to whether an injury occurred? If so, provide the doctor with a summary of what the employee alleges happened, as well as the carrier’s basis for denying or questioning the validity of the claim. Caution must be taken, however, not to reveal too much of the employer’s defense strategy, as the IME cover letter is discoverable and can and will be read by the employee’s counsel at the time of the doctor’s deposition whether is was written by the claims adjuster, a vendor, or defense counsel. Inflammatory statements about the employee, the employee’s medical providers, or the employee’s attorney will not be favorably looked upon by the Judge during litigation.
If you are seeking an IME on a claim that has already been accepted, it is crucial that you advise the doctor of the nature of the accepted injury, as well as any alleged injuries or diagnoses not already in the Notice of Compensation Payable. This is important as you do not want to get an IME report that questions or denies the occurrence of the accepted injury, or you will not be successful on any petition to terminate or suspend benefits based on an IME that does not recognize the accepted injury. The case law in Pennsylvania is very clear that a petition for termination must fail, and unreasonable contest counsel fees may be assessed, where the IME doctor does not recognize that the accepted diagnoses (whether by NCP or judicial decision) were caused by the work injury.
The second part of a good IME letter is the history. A succinct, unbiased summary of the medical treatment to date is helpful to the doctor in reviewing the medical history of the claim, and it can be compared easily to the history as provided by the employee. It is helpful to point out to the doctor any discrepancies in the medical records from what the employee alleged in his or her Claim Petition or in his or testimony, and any information regarding prior or subsequent injuries to the same body part.
The last part of the IME cover letter should include issues to be addressed that are specific to your case. For a Claim Petition, you should be asking the doctor whether an injury occurred, the nature of the injury, the extent of disability and whether the employee has recovered. If you have an accepted claim and there is no litigation, you should be asking the doctor if there is a full recovery, whether treatment to date is reasonable, necessary and related and whether the employee can return to work in a full or modified duty position. If the matter is in litigation on other petitions, such a claim for disfigurement or specific loss, a review petition to include additional injuries, or a petition to review Utilization Review, specific questions should be tailored to address the specific issues of the petition. If detailed questions are not posed to the doctor, you risk the possibility of the IME report not being sufficient to meet your burden, and you have to spend more money to request an addendum report from the doctor.
Following these tips should assist you in obtaining an IME report that is most useful in defending litigation or reducing your ongoing exposure, without jeopardizing your chances of success in bringing a claim to its conclusion.
For more information please contact Sherri Dougherty at firstname.lastname@example.org 215.972.7913
Disclaimer: The contents of this post are for informational purposes only, are not legal advice and do not create and attorney-client relationship.