Do I Have to Attend an Exam Scheduled by the Insurance Adjuster By a Doctor Who is Not Treating Me?

To be clear: though "independent" is in the name, this is not an independent or objective exam. This doctor is hired by the insurance adjuster and will likely post findings to their favor.  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 because 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 that 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 reason to terminate an injured workers benefits. However, when you do attend an IME be your own advocate: take notes of what the doctor asked you, how long he or she spoke with you, and the extent of the physical examination. These details could be important later on down the road if the employer tries to limit your beneifts based on an IME.

If you have more questions about the IME process or suspect that your recent IME is being used to limit your benefits, give us a free and confidential call today. You will speak to a real person who will take down your information. There is no cost or obligation to the initial inquiry so give us a call at 202-393-3320 or email us at [email protected]