Worker’s compensation insurance carriers often hire “Independent Medical Examiners” or “IME” doctors to review your claim. There is nothing “independent” about those doctors. They are hired guns. When your doctors support the work injury, ongoing treatment, and disability from the work injury, the insurance carrier is obligated by law to provide you with benefits unless they have a contrary opinion from an IME, or another defense. Sometimes the IME doctor will agree with you and your doctors but most of the time they do not.
Many doctors who provide these “independent” medical examinations make a lot of money examining dozens of worker’s compensation claims every month and they want to continue to be hired in this capacity.
If you see an IME doctor, the exam often lasts somewhere between 5 and 15 minutes. Then, later, you get a report about 10-20 pages long talking about how you had a strain or minor injury that resolved within a few weeks, or that you don’t need any more treatment. The IME doctor can also say that your current problems are due to a pre-existing condition that was not aggravated by the work injury, or say that you are no longer disabled due to the work injury.
You may not even see this doctor Instead the doctor may review your records and provide a written opinion on your condition without ever examining you, called an “Independent Record Review” or “Medical Record Review.” The worker’s compensation insurance company can obtain your medical records without an authorization once you claim a work injury (HIPAA privacy laws for medical records don’t apply once you make a claim for worker's compensation).
If your claim has been denied by an IME doctor or a medical record review, contact us right away. The good news is that most worker’s compensation judges know the score on these doctors, although that doesn’t mean you will win. Worker’s compensation judges are administrative judges who cannot take sides - they must preside over hearings for benefits in a fair and impartial manner. To be successful in winning your claim, you will need to present the best possible case against the insurance company - Luke Kingree, with his knowledge of the law and the system, will challenge the results of the IME or medical record review and work with your doctors to ensure that the judge knows the real cause of your injuries.