The workers compensation adjuster just scheduled me for an Independent Medical Examination, or IME, with a doctor they chose. What is an IME and do I have to attend?

 

A: First of all, this is no independent examination.  When a workers compensation insurance adjuster or nurse schedules this examination with a doctor they choose, it should be called a litigation exam or defense medical exam or insurance medical exam - that's what it is.  They are paying for the exam and report because they want to deny or limit your workers comp claim, or limit the medical treatment or surgery recommended by a treating doctor.

Typically insurance companies and employers use the same doctors or doctors' groups over and over regardless of whether the doctor specializes in treating a certain work related injury or condition.  And most of these doctors charge the insurance company 4 or 5 times what they charge for treating one of their own patients.

Whether you have to go to the so-called IME appointment depends on a number of factors.  Has the insurance nurse or adjuster scheduled repeat exams in a short time because they are doctor shopping?  Are these exams with doctors in the same specialty?  Is there a medical issue that warrants the exam.

A good rule of thumb in D.C. workers compensation cases is the insurance company is entitled to one exam in the same specialty approximately every 6 months, unless a surgical procedure is at issue.  They are entitled to these exams  periodically and not going to the exam could give the insurance carrier a reasonto terminate an injured workers benefits.