Michigan workers’ comp attorney discusses the independent medical examination and how to challenge biased medical reports.
If your doctor and the physician conducting your independent medical exam (IME) disagree, it’s important to consult a workers’ comp lawyer. An attorney can help you understand the impact of the disagreement, explain your rights, and guide you through the process of challenging the independent medical examination's findings to protect your benefits.
Employees who are on workers’ comp are routinely examined by a physician selected by the insurance company. These so called “independent” medical examinations are typically used for the purpose of a cut-off. Insurance companies use the same physicians over and over because they know what to expect. Some of these physicians make careers out of testifying against disabled employees and earn millions of dollars in the process. Clients have reported that an independent medical exam can take as little as 15 minutes and the physician barely examines them. We recommend attending the independent medical exam, but it’s wise to have an attorney in place in case your workers’ compensation benefits are stopped.
Unfortunately, it is common for an IME doctor to find a problem is not work-related. This can happen months or years after a claim has already been paid. They use incidental findings of arthritis or degeneration to say a medical condition is from old age. It does not matter that a problem started when the workplace accident occurred or that a treating physician believes it to be work-related. If your IME physician disagrees with your doctor and doesn't believe the injuries are work-related then medical treatment coverage from workers' comp is stopped.
Independent medical exam physicians are also notorious for saying that an employee has fully recovered and can return to work without any restrictions. This medical opinion is sometimes based upon surveillance video obtained by the insurance company who hired private investigators to spy on you. If your IME disagrees with your doctor and says you can return to work without any restrictions and your claim is disputed your benefits will be stopped.
What happens if my IME physician disagrees with my doctor?
In Michigan, if your IME doctor disagrees with your primary care doctor and your claim is disputed then workers' comp benefits are stopped. The burden is on the disabled employee to file an Application for Mediation or Hearing starting a formal process where the case is assigned to a magistrate to decide the outcome. It will be necessary to present medical evidence from a treating physician to challenge the biased independent medical examination. The magistrate will make a finding regarding payment of additional medical treatment and/or wage loss benefits. Our experience shows most of these cases are eventually settled for a lump sum cash payment.
We tell our clients to use their health insurance when medical treatment is cut-off. It is critical to have evidence of continuing disability for the workers’ comp case. Employees who settle their workers’ comp case will need to reimburse the health insurance company for any money it paid out. This is never a problem because an experienced attorney can negotiate liens and make sure medical bills get covered.
What to do if your IME physician disagrees with my doctor?
When the findings of your independent medical examination differ from those of your treating physician, it can create confusion and jeopardize your workers’ comp benefits. Knowing how to respond is critical to protecting your rights and ensuring you receive the care and compensation you deserve. There are several important steps to take if your IME physician disagrees with your doctor, ranging from consulting an experienced workers’ comp attorney to gathering supporting evidence and preparing for potential hearings. Following a clear, strategic approach can help resolve the disagreement and strengthen your case.
Consult with a workers comp attorney
If your independent medical examination (IME) disagrees with your treating doctor, consulting a workers’ compensation lawyer is essential. An experienced attorney can help you understand the discrepancies between the reports, explain how the independent medical examiniation’s findings could impact your benefits, and outline the options available to protect your rights. They serve as an advocate, ensuring that your voice is heard and that the insurance company cannot unfairly use the independent medical exam to deny or reduce your claim.
A workers’ comp lawyer can also guide you through the process of challenging the independent medical examination, including coordinating responses from your treating physician, gathering supporting evidence, or even requesting a second independent medical exam if necessary. Additionally, they can handle communications and negotiations with the insurance company, making sure any settlement or decision reflects the reality of your medical condition and work restrictions. Having legal support increases your chances of a favorable outcome and ensures that your case is handled efficiently and effectively.
Review the indepenent medical examination with your physician
If your IME disagrees with your doctor, it’s important to review the report carefully with your physician. They can help interpret findings, identify errors or omissions, and provide context for any discrepancies. Understanding the differences ensures you know how the independent medical examination might impact your case or treatment.
Discussing the independent medical examination with your physician also allows you to strategize next steps. Your physician can document their professional opinion in response, clarify your medical history, and prepare explanations for insurance adjusters or legal proceedings. This collaboration helps protect your rights and ensures your treatment and claim are accurately represented.
Gather evidence
When an IME disagrees with your doctor, it’s essential to gather strong evidence to protect your claim. Collect any documentation that contradicts the exam's findings, such as your own medical records, witness statements, or pain journals. This evidence helps reinforce your treating physician’s opinion and ensures your condition is accurately represented.
Gathering this evidence not only strengthens your case but also prevents the independent medical examination’s report from being the only perspective considered. Insurance companies and courts may rely heavily on the exam’s conclusions, so having detailed, credible documentation supports your credibility and shows the full impact of your condition. This proactive step ensures your voice and medical reality are not overlooked.
Request a second independent medical examiniation from another physician
When an IME disagrees with your doctor, you may have the option to seek another evaluation to ensure your condition is fairly represented. In some cases, your attorney may be able to request a second independent medical exam from a different physician, giving you the chance to present an additional medical opinion that supports your claim and counters the first exam’s findings.
A second independent medical exam can be critical for strengthening your case, especially if the first evaluation overlooked key details or minimized your condition. Having another independent physician review your records and conduct their own examination provides balance and credibility. This step not only reinforces your treating physician’s perspective but also demonstrates that your side is supported by multiple professional opinions, creating a clearer and more accurate picture of
Negotiate with the insurance company
When an IME disagrees with your doctor, it can create obstacles in your claim, but it doesn’t mean your case is lost. Your attorney can negotiate with the insurance company to reach a settlement that addresses your needs, even if the IME doctor disagrees with your doctor, by highlighting evidence that supports your condition.
During negotiations, your attorney may present medical records, testimony from your treating physician, or other documentation that demonstrates the extent of your injury or illness. The goal is to counter the independent medical examination’s opinion with stronger, credible evidence. This process can lead to a fairer settlement that reflects the true impact of your condition, ensuring your rights and health are taken seriously.
Consider using health insurance
When an IME disagrees with your doctor, it could result in your workers’ compensation benefits being reduced or even stopped. If your benefits are cut off based on the independent medical exam, you may need to utilize your health insurance for continued treatment, but be aware that you may need to reimburse your health insurance company later if your workers' compensation case is successful.
Using your health insurance in this situation ensures that you do not miss critical medical care while your case is still being resolved. Although it may create additional responsibilities, like potential reimbursement, it helps you stay on track with your recovery. This approach also demonstrates that you are committed to following medical advice, which can strengthen your claim as your case moves forward.
Is your IME doctor disagreeing with your doctor saying your injuries aren't work-related? Contact our work injury attorneys now for a free consultation!
If you were injured on the job and your IME physician is saying your injuries aren't work related and your doctor disagrees, call 855-221-2667 now, or fill out our contact form for a free consultation with an experienced workers' comp attorney. There is absolutely no cost or obligation. We’re here for you.
Our attorneys have been exclusively helping injured workers in Michigan for more than 40 years. Our attorneys can help you better understand Michigan laws and what happens after someone has been hurt on the job. To see what our own clients have to say about the caring, compassion, and communication they received from us, you can read in their own words about their experience here on our testimonials page from clients we have helped.
Michigan Workers Comp Lawyers never charges a fee to evaluate a potential case. Our law firm has represented injured and disabled workers exclusively for more than 40 years. Call 855-221-2667 for a free consultation today.
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