Injured workers are frequently sent for an “independent medical exam” (“IME”), so the employer’s comp insurance carrier can get a second opinion. This common practice sounds fair and innocent enough. In fact, it is laden with landmines which can be fatal to the injured worker’s compensation claim. Most of the hazards lurk just behind the cover letter asking for the injured worker’s treating doctor’s concurrence with the IME doctor’s report.
Please consider carefully the effect of your concurrence.
By concurring with the IME report, you go on record as agreeing with everything in the IME report. Your concurrence means you are in total agreement with every point in that report. You are not just in general agreement. You do not just agree with the diagnosis. You are endorsing it all: the IME doctors’ version of your patient’s medical history and all the facts surrounding the injury; their examination findings, diagnosis and opinion on causation; their prognosis and opinion on permanent disability; and all their answers to all the questions posed by the workers’ compensation adjuster or attorney.
As treating physician, your opinion carries great weight because of your opportunity to see and treat the injured worker. When you concur with an IME report, your seal of approval gives that report the weight and authority of your opinion as treating physician.
Under workers’ compensation law, your opinion as treating physician is required for determining the extent of your patient’s disability, unless you endorse another doctor’s opinion. Your concurrence may result in your relinquishing your authority to doctors who have been hired by an insurance company for the purpose of questioning your authority.
This calls for a very careful reading of the IME report. The compensability of your patient’s work injury – including pay for time loss, past present and future medical bills and compensation for permanent injury – hangs in the balance.
This calls not only for a very careful reading of the IME report, but also for specific comments backed by cogent explanations for each and every point at which you disagree.
Your concurrence may result in your relinquishing your authority to doctors who have been hired by an insurance company.
Lengthy IME reports are not only a challenge for you to read, but also may convey to the judge that they are better (more extensively) explained and more thoroughly documented than your opinion. This does not mean you have to make an equally lengthy response. But your response should be at least explained and should show that your knowledge of the facts is at least as extensive and detailed.
In your response, you may refer to specific chart notes detailing your prior examinations and treatment. If you have not seen your patient since the IME report was written, you may want to see your patient again to insure your knowledge is as complete and current as that of the IME doctors.
If you do not understand the significance of some of the questions posed to the IME doctors, it is always a good idea to consult with your patient’s legal counsel. If you need more time to do the job justice, call the person who sent you the report and ask for it.
Thoroughly and carefully reading and responding to an IME report before sending your response may save you time later and avoid misunderstandings potentially fatal to your patient’s injury claim. Your concurrence is not easy to undo. If you concur with the IME report and later realize you didn’t agree with some parts, those reviewing your patient’s claim will scrutinize your “change of opinion” very carefully. They will demand a convincing explanation. Anything less than a very careful and thorough reading before your response may put you in an awkward position and put your patient’s claim in jeopardy.
Therefore, if anything whatsoever in the IME report does not represent your perception of your patient’s condition and injury, and/or if any opinion is not your opinion, make that clear in your response.
Please answer all the questions that the IME doctors were asked to answer. If your answers do not match theirs, send in your answers, restating each question or at least referring to it by number.
Most importantly, again, explain your disagreement and back your explanation with specifics gained from your examinations, treatment and discussions with your patient. Obtain more information from or an additional examination of your patient as needed.
This article was prepared by Robert F. Webber.