When you’re injured on the job in Washington State, you have the right to pursue a workers’ compensation claim. As part of that claim, you also have the right to go to your own trusted doctor to receive medical treatment. In most cases, the Department of Labor and Industries (L&I) or your self-insured employer accepts your doctor’s evaluation and moves your claim along. However, in some cases, L&I may also request that you undergo an independent medical evaluation (IME).
These exams are not optional and can play a significant role in determining if your workers’ comp claim progresses and how much compensation you receive. While it may seem like the deck is stacked against you, you can and should prepare for your independent medical evaluation.
What Is an Independent Medical Evaluation?
An independent medical evaluation is, as the name implies, an evaluation of your current medical condition. It’s conducted by a qualified medical professional, including medical doctors, psychologists, or other licensed healthcare professionals, who have no relationship to you and have not treated your work-related injury.
Why Does L&I or Self-Insured Employers Request an Independent Medical Evaluation?
Under Washington State law, L&I, self-insured employers, and insurance carriers have the right to request an IME to help them better understand the nature and extent of your workplace injury. However, the IME can only be requested at certain points during the workers’ compensation claim process, such as:
- When reopening your claim
- A new medical issue arises (meaning you have a new medical condition that wasn’t present during any previous medical examinations)
- When you, L&I, or the employer is appealing
- To determine how your workers’ compensation case is progressing
- When establishing permanent partial disability (PPD)
- To determine work restrictions
What Happens During an Independent Medical Evaluation?
While the word “medical” is in there, an IME doesn’t mean “medical treatment.” Instead, the IME process is primarily aimed at helping L&I or your employer get answers about your workers’ compensation claim and your medical condition.
- Have you reached maximum medical improvement (MMI)? The doctor will assess your past treatment, current condition, and whether or not additional treatments or medical procedures will result in any additional and meaningful improvement.
- How likely is it that you have a permanent impairment, and how extensive is it? Some work accidents cause permanent injuries, but not all injuries are career-ending or require extensive, long-term care. The doctor will assess how severe your injury is and the impact it may have on your career and daily function.
- Are you exaggerating your injury? The doctor may test your function and pain levels using multiple methods to assess how severe your injury is compared to how severe you say it is.
- Is your injury related to your job duties? The doctor will also assess whether or not your injury was caused by work or something else. For example, someone with a preexisting condition (say, a slipped disc) may have back pain that comes and goes. The question for the doctor is whether or not the current pain you’re experiencing is caused by the job or something you did outside of work.
Who Pays for an Independent Medical Examination (and Why It Matters)?
While it’s called an independent medical examination or evaluation, “independent” may not mean what you think it means. When L&I or a self-insured employer requests an IME, you are not responsible for finding a doctor or paying for the independent medical exam. It’s up to the entity that requests the IME — meaning L&I or your employer. In theory, that sounds like a fair deal. You didn’t ask for the IME, so you shouldn’t have to handle the logistics or expense.
In practice, though, it means that L&I or your employer selects the examining physician from an approved list of IME doctors and pays for the examination. And often your employer, the insurance company, or L&I has an interest in limiting your compensation, not to mention IMEs are often requested to counter the findings of your attending physician.
When you realize that “independent” may not mean “neutral,” you begin to understand that independent medical examinations play a critical role in your workers’ compensation and why preparing for one is crucial.
What to Do Before and During Your Independent Medical Evaluation
In many respects, an independent medical evaluation is a straightforward process, consisting of two parts: an interview and a physical examination.
During the interview, the doctor will likely ask about your medical history, treatment, and current condition. The physical examination may consist of targeted tests (like grip strength or flexibility) to assess your pain level and functionality.
As straightforward as it looks on paper, though, it can be intimidating. But preparing in advance of the IME can help you feel more relaxed and confident during yours.
Before Your Examination
The insurance company or L&I must select a doctor located near your home from the approved IME physician list. From there, you’ll be scheduled for an independent medical examination, and you must receive written notice at least 28 days before the scheduled appointment, except for IMEs to address claim allowance, which is 14 days. In most cases, this will be an in-person appointment, but in some cases, your IME may be conducted virtually.
Make Sure You Go
When L&I or your employers request an independent medical examination, participation is not optional. Skipping your IME gives L&I the right to suspend your benefits, including your time-loss benefits. And while you don’t have to pay for an independent medical examination, you may have to pay the costs for missing one.
Bring a Witness
Consider bringing a witness with you to the exam to ensure you’re treated fairly throughout the IME process. Your witness can be a silent observer and can document what happens while you’re busy with the doctor.
You also have the right to record your independent medical exam as long as you (or your representative) notify the IME provider at least seven days in advance.
Assume You’re Being Observed
From the moment you drive into the parking lot, assume every medical professional you encounter is observing you. Any of those observations — like what you were doing in the waiting room or how you moved getting in or out of the car — can be included in their notes and as part of your medical record.
Be Honest But Brief
During the interview, the IME provider will ask a lot of questions. Some will be about your medical history and ability to work, while others may be very personal. Answer honestly about your medical history, treatment, and medications, as well as why you’re unable to work. Explain how the pain, weakness, or other symptoms prevent you from performing your job duties.
But also keep your answers brief and focused. You do not have to speculate, offer extra or unnecessary information, or answer questions that have nothing to do with your injury. When in doubt, only answer the question the provider is asking.
Do Not Underplay Your Condition
During the physical examination, you may feel discomfort or even pain, and downplay it because you think you’re supposed to be tough or worry that complaining is a sign of weakness.
But downplaying your pain or how it’s limiting your ability to function can negatively impact your claim. Describe your condition accurately and thoroughly. Even if you’re feeling great the day of the medical assessment, don’t understate how you feel most of the time.
Do Not Exaggerate Your Condition
On the flip side, the doctor will look for signs you’re exaggerating. Overstating your condition could undermine your credibility, and that will be used against you in the final report.
What Happens After an Independent Medical Evaluation?
After the examination, the doctor submits a written report to L&I or your employer. The information can impact decisions about your medical treatment, time-loss benefits, and impairment ratings.
Once you receive your copy of the IME report, review it carefully to ensure it accurately reflects your condition. The doctor will give their opinions on:
You should receive a copy of the IME report, and the doctor will weigh in on:
- If they think you are faking or exaggerating your injury
- Whether the injury is from your job duties or happened due to a non-work-related injury
- How preexisting conditions did or didn’t contribute to your injury
- If you are released to return to work or light-duty work
- Whether you need any additional treatment or other procedures
- If you’ve reached maximum medical improvement
- An impairment rating, but only if you’ve suffered serious damage to a body part, organ system, or organ function that causes a permanent disability
Can I Challenge an Independent Medical Evaluation?
It’s important to know that an IME is very different from a routine medical examination. First and foremost, there is no doctor-patient confidentiality. Anything you say or do throughout the independent medical examination can be included in the final IME report.
And not all reports are accurate or have fair conclusions. Sometimes the doctor places too much emphasis on your medical history and preexisting conditions, minimizes your symptoms, or doesn’t accurately describe your limitations.
You have the right to challenge the IME report using information from your treating physician. Medical records, test results, and other documents can be presented to dispute the IME doctor’s findings.
Walthew Law Firm Is on Your Side
An independent medical evaluation plays an important role in the workers’ compensation process. The doctor’s opinion can lay the foundation for the compensation and benefits L&I or your employer pays you, and an IME that doesn’t accurately reflect your condition could mean you recover far less than you should.
For over 90 years, Walthew Law Firm has fought on behalf of injured workers. Our experienced team of workers’ compensation lawyers is on your side, protecting your rights and fighting for what you deserve. If L&I has asked you to participate in an IME, call us today. We’ll guide you through the process and ensure you’re treated fairly.
With offices in Seattle and Everett, we’re here to help every injured worker throughout Western Washington. Contact us today for a free, no-obligation, and confidential consultation. There’s no fee unless you win.