Insurer's Independent Medical Exam

When someone is hurt on the job in the state of New York, he or she is entitled to pursue benefits under our state’s workers’ compensation laws. Some of the most important benefits, to which a worker may be entitled, include medical care paid for by the employer or its workers’ compensation insurance carrier, temporary total disability benefits, and, if the employee is permanently disabled either totally or partially, permanent disability benefits. The employer, too, has specific rights under the law. This includes an insurer’s independent medical exam (IME), an examination by a doctor selected by and paid by the employer or its insurance carrier. If you have been hurt at work and need to know more about your rights and your employer’s responsibilities, including what to expect during an IME, the Law Firm of Valerie J. Crown, Attorney at Law, P.C., is here to be of service to you. Our Rockland County workers’ compensation attorneys consider it a privilege to represent you as you pursue the full workers’ compensation benefits to which you may be entitled under the law.

In most workers’ compensation cases, neither the worker’s treating physician nor the doctor, retained by the insurer for its independent medical exam, are actually present during the workers’ compensation tribunal’s hearing(s) on the worker’s case. However, the physicians’ records will be considered (assuming they are properly admitted into evidence) to aid the administrative law judge in deciding the issues. The injured worker must submit to the independent medical examination if duly requested to do so by the workers’ compensation insurance company. The worker may also want to hire his or her own IME doctor for a separate evaluation in some cases.

It is important to note that the IME doctor, retained by the insurer, is not the same doctor who has been treating the injured employee for the work-related injury at issue, nor is the IME doctor to be considered a “second opinion,” in the traditional sense. Rather, an IME doctor is someone, who is hired by the insurance company that will ultimately foot the bill for all of the medical benefits to which the state workers’ compensation tribunal determines the worker to be entitled. Thus, the insurance company is likely to choose a doctor whom it believes will be more likely to assist it in denying, terminating, or reducing the benefits that it must pay the injured employee than a physician that will help strengthen the worker’s claim for full and fair workers’ compensation benefits. Notably, some insurance companies tend to use the same doctors over and over again for their IMEs, developing a relationship with these professionals.

Although it may seem unfair, the injured worker does have an obligation to undergo an insurer’s independent medical exam if requested to do so. It is therefore advisable that the worker talk to an experienced worker’s compensation attorney before reporting for such an examination. An attorney, who handles these types of cases, can go over the worker’s case in detail and let him or her know about potential pitfalls (such as answering certain inappropriate questions during the IME) to minimize the damage done to the employee’s case by the examination. An attorney can also help the employee arrange for his or her own IME with a different doctor – preferably, one who is more fair-minded and whose practice is not necessarily in allegiance with the insurance company.

Although an injured worker is not legally required to hire a lawyer to represent him or her in a workers’ compensation case, it is often best to do so, especially if an independent medical examination is requested by the insurance company. An attorney can help the worker understand his or her legal rights, deal with the employer’s workers’ compensation insurance company, and gather evidence to support the employee’s claim for maximum benefits. To schedule a free case evaluation with an experienced Rockland County workers compensation attorney, please call the Law Firm of Valerie J. Crown, Attorney at Law, P.C., today at 845-708-5900, call Valerie 24/7 on her cell phone at 845-598-8253, or contact us online. We represent injured workers in claims and appeals throughout Rockland County and Greater New York, including in Westchester, Orange, and Dutchess Counties.