In New Jersey, workplace injuries and illnesses are governed by the workers’ compensation system. Workers’ comp is a type of insurance that all New Jersey employers are required to carry. In the event that an employee is injured or becomes ill due to a workplace accident or exposure, they are covered by this insurance regardless of fault.
While workers’ comp may seem relatively straightforward, in practice, it can be quite complex. Insurance companies are businesses, and they don’t make money by paying out on claims. In the workers’ comp world, denying or minimizing legitimate claims is an unfortunate reality.
If you have been hurt at work, you may receive a request for an Independent Medical Evaluation (IME). This can be confusing, as you are already have been diagnosed with a medical condition and are receiving treatment for it. Understanding what an IME is and your obligations under the law can help you decide how to handle this request.
IMEs play a significant role in New Jersey workers’ comp cases, particularly where there is an issue in dispute, such as whether your injury or illness is work-related if you can return to work or the need for ongoing treatment. A Cherry Hill workers’ compensation attorney can advise you on how to handle a request for an IME — and even be with you for the exam.
What Is an IME?
An IME is a type of medical examination that is requested by the workers’ compensation insurance company. In most cases, an IME is requested because the insurer disagrees with a decision made by your physician, either about your treatment or about the extent of your disability. In some cases, a judge or hearing officer in a workers’ comp case will order an IME to resolve a disputed issue.
The doctor who performs an IME is neutral — in theory. An IME should be an objective evaluation of your medical condition, which includes the treatment that you need, whether you have a permanent disability, the extent of your disability, and whether you will be able to work in the future. However, because the physician who performs an IME is often selected and paid by the insurance company, these exams should be approached with caution. In fact, in worker’s compensation, generally each side (you and the insurer) will obtain your own IME. Because of this, each doctor will generally resolve doubt in favor of their side. Where the two sides can’t agree on the outcome, sometimes a worker’s compensation judge will order a third IME selected by the court, or agreed upon by both parties.
Before an IME, the doctor will receive your medical records and other information relevant to your work-related injury or illness. This may include the report that you filed with your employer or any statements that you made about how you incurred the injury or illness. It may also include any surveillance that had already been conducted. The insurance company may also submit a letter explaining its view of the case and asking specific questions to the IME doctor, such as:
- Have you been diagnosed correctly?
- Was your injury or illness caused by an injury or exposure on the job?
- Do you need additional medical treatment or testing for your medical condition? If so, what kind of testing or treatment?
- Do you have a permanent disability? If so, to what extent are you disabled?
- When will you be able to return to work?
- Will you have any restrictions upon your return to work?
During the evaluation itself, you do not have any of the normal protections of the doctor-patient relationship. This means that anything that you say — and even the things that you do — can be used against you in your workers’ comp case. Remember that this doctor is being paid by the insurance company!
The IME physician will ask you questions about how the injury or illness happened, discuss your medical history, and talk about your treatment to date. The doctor will conduct a physical exam and run tests. The exact type of examination and tests will depend on your medical condition.
After the IME, the doctor will write a report, giving their conclusions and addressing the questions raised by the insurance company. This report is often given substantial weight, as it is viewed as more objective than an opinion from your treating physician. If there are any errors in the report, your attorney can ask to correct them.
Do I Have to Attend an IME?
If the insurance company has requested that you attend an IME, then you have to go — or risk having your workers’ comp benefits terminated. Under New Jersey law, refusing to attend an IME is grounds for a cessation of benefits, for as long as the employee continues to refuse to go.
However, an insurer generally cannot require you to travel long distances in order to complete an IME. In that situation, you may be within your rights to refuse an IME. The examination must be scheduled within a “reasonable time and place.” In other words, if the IME is not in a convenient time and place, you may be able to refuse to attend.
The insurer is required to pay for all fees associated with an IME it orders. The doctor that performs the IME is usually selected by the insurance company. When it is time to settle the case, or if treatment has been denied and you need an opinion to support additional care, your Cherry Hill workers’ compensation attorney will select an IME physician to offer an opinion on your behalf. In this case, you will either be responsible for the cost, or the cost will be split between you and the insurance company at the end of your case.
If an IME has been requested, you may have to complete more than one exam — but only as many as is reasonable under the circumstances. While this is inconvenient, it may be necessary in order for the doctor to understand the full scope of your medical condition. At the examination, you can have a witness present during the exam, such as your attorney or your own doctor. You are also permitted to record the session and to obtain copies of the reports and underlying test results.
Finally, if you are requested for an IME, you can request that the exam be made by a doctor of the same sex as you. This is an important right for many employees whose injuries or illnesses are more sensitive in nature, and who may not otherwise be able to exercise much choice in which the doctor performs the evaluation.
We Are Here to Help
If you are out of work due to a job-related illness or injury, you are likely stressed and overwhelmed as you deal with the double burden of workers’ compensation and financial strain. A skilled Cherry Hill workers’ compensation attorney can guide you through the process, advocating for your right to benefits. This includes helping you prepare for an IME and being there with you during the exam itself.
Bross & Frankel represented clients in New Jersey and Pennsylvania in getting workers’ compensation benefits for more than 20 years. We understand the system, and we are dedicated to helping people like you. Contact us today at 856-795-8880 or online to schedule a free initial consultation with a member of our team.