Independent Medical Examinations: What You Should Know

When you file a worker’s compensation claim with your employer after an injury on the job, you must keep up with your medical appointments. You will have to attend your appointments to ensure you receive your worker’s compensation benefits. Failure to do so can mean you will receive a denial, which leaves you with no financial recourse for your injury.

Over the course of your medical treatment, your employer may require you to visit an independent physician for a second opinion if the employer’s insurance company asks for it. When you receive notice to see an independent medical examiner, you may have some questions about the process. Here are some things you should know about.

What Constitutes an Independent Medical Exam?

During an independent medical exam, you will receive a check-up by a medical provider. After the appointment, the medical provider will document his or her opinion about your illness or injury. The report goes to your employer’s worker’s compensation insurance company for evaluation.

The goal of the insurance company is to investigate your condition to determine if the illness or injury is compensable under their worker’s compensation coverage. The insurer will look at the details of your condition along with the treatment you received from your prior medical provider. They will also check to determine if the prior medical treatment was appropriate.

If your worker’s compensation claim includes a permanent disability, the insurance company will look at your overall ability to earn money through work, and determine if you can still work in some capacity.

Is the Appointment for the Independent Medical Exam Mandatory?

Your employer’s worker’s compensation insurer expects you to attend the appointment, and your attorney will likely strongly encourage you to do so. If you do not go to your appointment, the administrative law judge in your case can prevent you from receiving any benefits until you attend.

If there is a conflict in your schedule and you cannot make your appointment, you can ask to reschedule your appointment. If you reschedule, you need to let your attorney know, along with the worker’s compensation insurance company. You may be liable for additional fees if you do not provide adequate notice.

What Is Maximum Medical Improvement?

The second opinion from the medical provider in your independent medical exam may indicate you reached the maximum medical improvement. If this happens, it means that your injury or illness reached a limit at which further medical treatment will not improve your condition. When you reach maximum medical improvement, the insurance company can cease your benefits.

When Should You Involve an Attorney?

While an attorney is not necessary during the initial filing stage for your worker’s compensation claim, you may want to choose someone to work in case you need help at a later date. Worker’s compensation claims can be complex, and you may become confused, particularly if your injury or illness is severe.

If you are not already working with an attorney, you should do so as soon as you receive notice of an independent medical exam. Your attorney will help guide you through the process and ensure you receive proper representation. If you are asked to appear before an administrative law judge, or if you wish to appeal the maximum medical improvement status, your attorney can help.

If you need assistance with any portion of your worker’s compensation claim, please contact us at Stafford, Neal & Soule, S.C. We work hard to help our clients get the fairest deal possible when it comes to injury claims. We look forward to helping you through this difficult and often frustrating process.