INDEPENDENT MEDICAL EXAMINATIONS - IME

If your doctor and your employer's doctor disagree about your medical condition or your need for medical treatment, the Louisiana Office of Workers Compensation Medical Services Division or a Louisiana Workers Compensation Judge may select a third doctor to perform an Independent Medical Examination.

Though both you and your employer have the right to request an Independent Medical Examination, the cost of the exam will always be paid by the insurance company.  Unfortunately, Louisiana Workers Compensation insurance company representatives often tell injured employees that they have arranged an Independent Medical Examination, when in reality, what they mean is that they have scheduled a Second Medical Opinion. Written notice of a true Independent Medical Examination will come to you directly from the Louisiana Office of Workers Compensation Medical Services Division or from the Louisiana Workers Compensation Court.

Your attorney and the Louisiana Workers Compensation insurance company should provide the doctor who performs the Independent Medical Examination with copies of all of your medical records. But you are not supposed to contact the doctor who performs the Independent Medical Examination except to schedule the appointment and go to the exam. You should discuss with your attorney whether you are allowed to take along copies of your medical records or diagnostic films for the doctor to review. 

The doctor that performs the Independent Medical Examination will send the report of the examination directly to the Louisiana Office of Workers Compensation Medical Services Division or to the Louisiana Workers Compensation Judge who will decide your case.

If your doctor reports that you need surgery, the insurance company's disagrees and doctor who performs the Independent Medical Examination agrees with your treating physician, the Louisiana Workers Compensation insurance company will almost certainly approve the treatment.

Conversely, if your doctor reports that you need surgery, the insurance company's disagrees and doctor who performs the Independent Medical Examination agrees with the insurance company doctor, then you have a problem. The Louisiana Workers Compensation insurance company is very, very, unlikely to approve your treatment if the Independent Medical Examiner has decided against your request. It occasionally happens, but only in highly unusual circumstances.

You can appeal to the Louisiana Office of Workers Compensation.  The Louisiana Workers Compensation Judge is not supposed to just go along with whatever the Independent Medical Examiner says. The Judge is supposed to weigh the medical evidence according to the appropriate legal standard and issue an independent decision.

We tend to have very fair and unpredictable Judges in the Louisiana Workers Compensation system and in the overwhelming majority of cases, a claimant can feel confident that the Judge has considered all of the evidence and tried to make an impartial decision.

Nonetheless, if the Independent Medical Examination goes against you, you should be talking with your attorney about alternative ways to get your treatment covered while your claim is working its way through the Louisiana Workers Compensation legal system

Therefore, you do not want to prepare for an Independent Medical Examination by simply crossing your fingers. There are many things to consider:

• Should you be having an Independent Medical Examination in the first place? Are there really conflicting medical opinions? Should you file an objection to being required to go to an IME? And what is likely to happen to your case if the Louisiana Office of Workers Compensation agrees with your objection and cancels the examination?
   
• You want to be certain that all of your medical records and copies of your diagnostic films have been submitted to the doctor who will perform the Independent Medical Examination.
   
• You would like to know what else has been submitted to the doctor. You would like to know whether they have been provided information other than your medical records.  Has the doctor been provided with any "summaries" prepared by the Workers Compensation insurance company or their lawyer? What questions has the doctor been asked to answer?
   
  
• What are you going to tell the doctor about your medical condition? Are you going to appear to be a "reasonable candidate for a good outcome" for surgery from a psychological perspective? Do you have other medical conditions other than your work-related injury that the IME doctor should know about?
     
• Would it be a good idea to ask your primary treating physician for a supplemental medical report explaining why the treatment they recommended is exactly the type of treatment you need? If you get a supplemental report, how do you legally submit it to the IME doctor without violating the Louisiana Workers' Compensation laws?

Independent Medical Examinations are an important part of the Louisiana Workers Compensation legal system. And it's important that you understand your rights and responsibilities in requesting and attending the Independent Medical Examination.

Next: Obtaining Your Medical Records