Suppose you file for a worker’s compensation, but there is a dispute with your employer’s insurance company about the credibility of your issue. In that case, you may need to undergo an independent medical evaluation in Pittsburgh, PA, with a neutral doctor who gives a second or unbiased opinion. The results of this examination significantly affect your worker’s compensation claims and how much you will receive in benefits. For this reason, it is essential to understand how an independent medical evaluation works and what to expect during the examination.

What happens during an independent medical examination?

Before the evaluation, your IME doctor will have received medical records and any other information relevant to your injuries, including the statements and report given in your case. Your doctor may review these documents before or after the medical examination. Sometimes the insurance company writes a letter to the doctor, especially if there is a significant disagreement in your case. They may pose specific questions about your medical conditions to help frame the issues for the IME doctor. Examples of these questions include:

• Do you have a correct diagnosis of the condition that you claim?
• Is the course of your treatment necessary? For example, do you need additional medical treatment for your condition? Your physician may have recommended surgery which sometimes may not be required.
• Did your current symptoms result from a work-related accident or exposure? The question is meant to ensure that you didn’t develop this condition through off-duty conduct or other personal activities.
• Does your condition limit your productivity or pose restrictions on what you can do at work, such as not standing for long periods.
• Has your injury resulted in permanent disability, and to what extent?

Unfortunately, there’s a possibility of factual mistakes in the letter sent to the independent medical examination doctor. For this reason, you should ask to review any letter sent to the IME doctor to ensure the questions asked are appropriate. If you can, make your request in writing and file a copy with the state agency in which your worker’s compensation claim is pending.

The relationship between you and the IME doctor is different from that of your regular physician. For example, there is no confidentiality, meaning none of your statements are protected in any way. It is important to note that what you tell the doctor could be used against you if your case requires a worker’s compensation hearing. For example, if the doctor sees you walking normally from your car to the office but then you suddenly begin limping in the office, they will take note of that.

Any inconsistency in your behavior or words will show up in the doctor’s report, and the hearing officer takes that into account when assessing your credibility. For the examination, the IME doctor will likely ask you questions, including how your injury happened and the course of treatment so far. Expect physical tests that allow the doctor to measure your range of motion and grip strength.

After the examination, the IME doctor writes a report with conclusions, especially in response to the questions raised by the insurance company.

Consult with your Steel City Spine and Orthopedic Center doctor for further inquiries about independent medical evaluation.