What Cases Justify an Independent Medical Examination for Workers Compensation banner

By westgate November 2, 2022

What Cases Justify an Independent Medical Examination for Workers Compensation

If an employee is injured on the job, workers’ compensation will usually cover the associated costs to get the employee healthy again. This may include medical expenses, wage replacement, or even vocational rehab to ensure the employee regains the ability to work in some capacity. Needless to say, workers’ compensation can be expensive for the employer, and a huge burden of time for the injured employee who is out of work.

If there is a disagreement between the employer and employee over the workers’ compensation claim, an Independent Medical Examination may be requested on behalf of the employer’s insurance company. While an employee may have the option to choose the doctor they see for treatment, an Independent Medical Examination utilizes a neutral medical professional to verify or clarify treatment plans. An Independent Medical Examination serves as a mediator between the treating doctor and insurance company to ensure that covered medical costs are necessary and timely.

During an Independent Medical Examination, a third-party physician will review your medical records and injury report. During the exam, the medical professional will confirm the existence of the claimed injury, ensure that the diagnosis is correct, and determine if the injury or related symptoms were present before or just after the time of the accident. They will also review the treatment plan and prognosis for returning to work.

Independent Medical Examinations can be requested for any number of reasons, such as:

  • There is a disagreement between the treating doctor and insurance company over the necessity of surgery as part of the treatment plan.
  • The treating doctor claims that more time is needed off of work than should be medically necessary.
  • An employee claims to be disabled from a workplace injury, but is seen performing tasks that they “can’t do” outside of work.
  • The insurance company suspects that the employee has been incorrectly diagnosed.

Independent Medical Examinations are a source of protection for both injured employees and their employer’s workers’ compensation insurance company. The results of an Independent Medical Examination can protect an employee from being short-changed on their road to recovery. The results can also protect the insurance company from bogus injury claims.