Are you dealing with an Independent Medical Examination (IME) in your L&I claim? Did the examiner provide a high-quality, unbiased, accurate and medically-sound report? Did your attending physician review the IME report? Here are some tips and things you need to know.
Independent Medical Exam (IME)
The open and active phase of a workers’ compensation or L&I claim is when the work injury claimant receives medical treatment. This phase begins to wind down as the worker approaches maximum medical improvement (MMI). Maximum medical improvement doesn’t necessarily mean the work injury claimant returns to their pre-injury level of health. Often, workers still have permanent residual conditions as a result of their work injury or occupational disease.
Maximum medical improvement (or medical fixity) is when all available medical treatment is complete. This includes diagnostic tests, rehabilitative treatment, or curative care. In short, it means there’s no additional medical treatment that is going to improve the worker’s health. Personally, from my experience, the vast majority of work injury claimants want to use their L&I claim to recover. Therefore, when workers make less than optimal recovery, it’s often devastating when doctors tell them they reached MMI. The issue of maximum medical improvement can become even more frustrating. For example, when there’s a disagreement between medical professionals. One might argue that the worker is MMI, while another insists on additional treatment.
IME in your L&I claim
It’s common for the Department of Labor and Industries (L&I) or a third party administrator (TPA) to request an Independent Medical Examination (IME). In fact, IME exams are common during the course of an open and active claim. Typically, an IME evaluates and documents the worker’s condition for which L&I provides coverage under the Industrial Insurance Act. Furthermore, IME doctors may decide whether the work injury claimant achieved maximum benefit from their treatments. They can also determine if any permanent impairments remain.
According to L&I, high-quality exams provide unbiased, accurate, and medically-sound information. The exams help the insurer give appropriate assistance and make fair decisions throughout your L&I claim. However, there are constant arguments as to whether IME exams actually provide high-quality, unbiased, accurate and medically-sound information. Nonetheless, L&I has the right to compel work injury claimants to attend independent medical examinations. The only requirement is for L&I to provide 14 days notice prior to the examination. On top, the IME examination must be at a location reasonably convenient to the work injury claimant. Unfortunately, this second requirement poses problems for many clients I represent who live in rural parts of Washington State. There are no IME facilities available in some of these cases. Yet, L&I can reimburse work injury claimants for traveling to an IME exam. Also, in some circumstances, L&I can provide assistance with travel arrangements.
Issues that can impact your L&I claim
When the IME is complete, the examiners write their opinions and submit their report to L&I. It’s always important to review the IME report carefully and thoroughly. Moreover, it’s important to submit the entire IME report to your attending provider (AP). The attending physician must review the report and respond. It’s always surprising to me how many times this is not done. Sometimes, L&I forgets to ask the attending provider to comment on the IME. Other times, the attending provider only receives the IME opinions, to concur or disagree.
Under the Industrial Insurance Act, the opinions of the attending provider are very important. It’s absolutely essential that the attending provider gets a full opportunity to carefully review and reply to the whole IME report. This also includes the IME’s findings and conclusions. For me, I often tell work injury claimants the following. If there’s ever a disagreement between the opinions of an attending provider and the IME, then call a good workers’ compensation L&I attorney. Especially if the insurance provider decides to take the opinion of the IME over the opinions of the attending physician.
Additional resources: Find an IME provider in Washington State