In the state of Georgia, employees who become ill or injured due to their job can receive disability benefits through the workers’ compensation system, administered by the State Board of Workers’ Compensation.
But what happens when there’s a dispute over the extent or nature of an employee’s injuries? Or what happens when there’s a disagreement regarding the validity of their claim? This is where an Independent Medical Examination (IME) comes in.
Keep reading to see what an IME means, its purpose in Georgia work comp, and how it can affect your case. Also, discover what to do before and during the exam and when it’s best to seek legal counsel from a workers’ compensation attorney.
What Does Independent Medical Examination Mean?
An IME is a “neutral, objective” evaluation performed by a doctor who is not involved in the employee’s ongoing treatment. The IME can help resolve disputes and determine the appropriate benefits for the injured worker. So, it is not a medical treatment session but a legal process to reach an agreement between insurance companies and work injury victims during settlement negotiations. The exam is supposed to be “neutral” but in reality, insurance companies can easily find “hired guns” who support their position and vice versa.
When an employee has a workers’ compensation claim with their employer, the insurance company or self-insured employer has the right to request a defense medical exam. This defense medical examination, IME, allows them to seek a second opinion from a physician who is not the employee’s treating doctor.
During the examination, the doctor will examine the employee, review medical records, and possibly perform additional tests to understand the employee’s condition. The results of the IME will provide a clear understanding of the employee’s physical condition and the need for further medical attention.
The Purpose of IME in Georgia Work Comp
The objective of IMEs is to provide a fair resolution to medical disputes between the employee and the employer’s insurance company.
For example, the insurance company or self-insured employer may want to verify if previous injuries contributed to the current case and if they should be held responsible. They may also want to confirm if the medical procedures and treatments recommended by the employee’s private doctor are necessary and when they can return to normal activities and stop receiving lost wages.
The outcome of the IME should provide the most objective evaluation of the employee’s injuries, their severity, and the probable cause. This information will then be presented to the judge, who will decide whether the insurance company or self-insured employer should cover the employee’s medical expenses.
But while the outcome of the IME is crucial for any legal proceedings related to the worker’s compensation claim, these exams are less impartial than they appear to be. Why? Because the insurance company or self-insured employer selects and compensates the doctors performing IMEs.
So, while their purpose is to examine the injured worker and verify their workers’ compensation claims, they often try to uncover evidence that excuses the insurance company from paying the claim. And this is why you need to seek legal guidance from an experienced workers’ compensation attorney in Georgia.
Experienced workers’ compensation attorneys can assist in preparing you for the medical exam and protecting your rights. So, ensure your attorney receives a copy of the IME doctor’s report. With it, they can help you contest any inconsistencies or inaccuracies compared to the treating physician’s statements.
How IMEs Works in Georgia Workers’ Compensation
The Georgia Workers’ Compensation Act grants the employer or insurance company the authority to compel an injured worker to undergo an IME. It also allows an injured worker to obtain their own “IME” or second opinion. Whether or not that is paid for by the employer/insurer depends on whether the injured worker has received weekly compensation benefits.
Generally, here’s how it goes:
- The employer’s insurance company requests an IME when there’s a dispute about the extent or nature of the injury.
- The employee gets a notice to attend the IME conducted by a doctor chosen by the insurance company.
- The doctor will review the employee’s medical records, conduct a physical examination, and provide a written report.
- The report will determine the employee’s entitlement to workers’ compensation benefits.
If the injured worker has received workers’ compensation income benefits within the last 120 days, they are entitled to one IME of their own, subject to certain cost limitaitons. In this case, the injured worker may select a physician in the vicinity, and the employer/insurer must cover the cost, subject to limitations. However, the injured worker must provide prior notification of the IME.
A skilled workers’ compensation attorney can assist you in exercising this right and securing an appointment with the appropriate doctor. This is important because an alternative medical assessment conducted by a physician of the employee’s choice can be valuable to the employee.
How Can IME Affect Your Workers’ Compensation Case?
The results of an IME can significantly impact a workers’ compensation claim. If the IME supports the employee’s claim, they may be eligible for disability benefits such as medical treatment, rehabilitation, and lost wage compensation. However, if the IME finds that the employee’s injuries are not work-related, their claim may be denied.
The IME doctor’s report is distributed to you and your attorney (if you already have one) before a potential court hearing. And despite the potential bias of IME doctors towards insurance companies, their medical opinions carry weight with workers’ compensation judges, who view them as a more impartial party than the treating physician.
As a result, even if you are entitled to compensation, the insurance company may reduce or reject your workers’ comp claim if the IME doctor’s report proves otherwise. And this is all the more reason to get an expert workers’ compensation lawyer.
Steps to Take Before the Medical Exam
If you wish to proceed with your workers’ compensation claim, it is advisable to mentally and emotionally prepare for this examination so that you are not caught off guard when the request comes.
Before attending an IME, it’s essential to take the following steps:
- Review your medical records: Ensure you clearly understand your medical history, including previous injuries and illnesses. This information will help you answer the doctor accurately during the IME.
- Collect as much documentation as possible: Gather all the relevant medical records, including doctor’s reports, test results, and treatment records. This information will help the doctor understand the extent and cause of your work injury.
- Research the doctor: Find out who will perform the IME, their background, and their reputation within the medical community.
- Prepare for questions: Think about the questions you may be asked during the exam and how you want to answer them.
- Get a second opinion: It is good to seek a second medical opinion before the IME to better understand your condition and the exam’s potential outcomes.
- Tell the doctor about the symptoms you are experiencing currently: Make sure to inform the doctor about the symptoms you are currently experiencing. This will help the doctor determine the extent of your impairment (impairment rating) and the need for medical treatment.
- Seek legal advice: Consult a Georgia workers’ compensation attorney for guidance and support throughout the process.
What to Avoid During an IME in Georgia
During the IME, your actions can significantly impact the outcome of your workers’ compensation claim. To ensure the best possible results, you should be aware of the common pitfalls to avoid during the IME process.
The following is a list of things to avoid during an IME in Georgia.
- Being unprepared for the exam
- Failing to disclose all of your medical history
- Not providing accurate information about your injuries
- Exaggerating your symptoms or abilities
- Being aggressive or argumentative with the doctor
- Downplaying your symptoms
- Making false statements
- Failing to ask questions about the exam or its results
- Signing documents without reading and understanding it first
- Not seeking legal advice from an experienced workers’ compensation lawyer before and after the exam.
When to Consult a Georgia Workers’ Compensation Attorney
A workers’ compensation attorney can help protect your rights and ensure you receive the benefits you are entitled to under the workers’ compensation laws. So, it is recommended to consult a Georgia workers’ compensation attorney in the following situations:
- If you have been injured on the job and need assistance navigating the workers’ compensation claim process.
- When your employer or their insurance company denies your claim.
- You are unable to reach a settlement agreement with the insurance company.
- If you are unsure of your rights and benefits under the Georgia Workers’ Compensation Act.
- If you face retaliation or discrimination for filing a workers’ compensation claim.
- You are offered a lump-sum settlement and are unsure if it is fair and adequate.
- If your medical treatment is not covered or you have trouble getting needed medical care.
An experienced workers’ compensation attorney can advise you on your rights and represent you during the IME and any subsequent workers’ compensation hearing. They can also help you navigate the complex workers’ compensation system and ensure that you receive fair treatment.
Navigating a Workers’ Compensation Claim Alone Could be Frustrating. We’re Here to Make it Easy!
If you have been injured on the job, you should get workers’ compensation benefits to cover the costs of your medical care and lost wages. But sometimes, it can be difficult to navigate this claim alone, and things can quickly become complex and overwhelming, especially if your employer fails to accept your claims. And this is where we come in.
You don’t want insurance companies and IME doctors denying you your benefits as this will only add to the physical and emotional toll of your injury. And that’s why our team of experienced workers’ compensation lawyers is here to guide you through every step of the claims process and fight for your rights.
At Gearhart Law Group, we have a proven track record of success in helping our clients secure the benefits they need to get back on their feet. Contact us today to schedule a free consultation with one of our experienced workers’ compensation attorneys. Let us help you get the benefits you deserve!
