The purpose of an IME
The purpose of an Independent Medical Examination (“IME”) in a workers’ compensation claim is to determine the cause of injury (causal relationship) and the extent of the disability from the injury. The IME can also be utilized to determine if there is any further causally related disability, maximum medical improvement and permanency.
By obtaining an IME, the employer/carrier is better able to make fair decisions on how to handle the claim. The IME provides the necessary information in considering whether to discontinue medical treatment, to continue medical treatment, to change medical treatment, and to determine the appropriate permanent partial disability benefit or permanent total disability benefit.
When to get an IME?
An IME should be obtained to dispute ongoing care, to challenge the necessity of specific treatment under the Medical Treatment Guidelines, and to contest nature and degree of permanent disability. Generally, the IME documents the claimant’s medical condition based upon a review of relevant medical records and a physical examination of the claimant. An IME also provides the employer/carrier with an independent verification as to whether the claimant’s alleged disability is causally related to a work accident.
If the claimant alleges more than one aspect of his/her health in question, more than one IME may be necessary. For instance, if the claimant alleges that he/she suffered an injury the head and neck, claiming such injuries to be orthopedic and neurological in nature, it would be proper to obtain IME’s from both an orthopedic surgeon and a neurologist.
Who can perform an IME?
An IME should be performed by a physician who specializes in the field of medicine routinely treating the type of injury the employee has incurred.
New York Workers’ Compensation Law Section 137(5) provides in pertinent part:
All independent medical examinations shall be performed by a practitioner competent to evaluate or examine the injury or disease from which the injured worker suffers. Such examination shall be performed by a practitioner who is licensed and board certified in the state of New York or any other person authorized to examine or evaluate injury or illness by the board.
Further, the IME physician should not have a prior relationship with the claimant or provided medical care either for the injury in question or for any other medical care. It is important to remember that an IME does not create a doctor-patient relationship.
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