After you have suffered an injury while working in the maritime industry, your employer or its insurance company may ask that you submit to an independent medical examination (IME). This usually occurs after you have been receiving benefits for a month or longer, or if you have requested payment for surgery or another expensive medical treatment for a maritime injury. While it may seem understandable that the insurer wants a second opinion, you should be aware that these evaluations are far from independent, and are often used to deny or reduce benefits.
What Injured Workers Can Expect During an Independent Medical Exam
Although it is commonly called an “independent” examination, the medical exam is paid for by the insurer—and the doctor is chosen specifically by the insurance company. The sole purpose of the IME is to obtain information for the employer and insurer. If the IME doctor disagrees with your treating physician about the extent of your injury or disability rating, your benefits may be reduced or even terminated. Worst of all, if the patient refuses to submit to an IME, the insurer can use this refusal to terminate benefits.
The physician performing the IME can use any information provided to make a judgment on the patient’s condition, including:
- Documentation. The IME doctor will likely request copies of your medical records and other documents related to your injuries, including the incident report and any statements you have provided to the employer or insurer. If the doctor has full access to your records, he or she may place the blame for your disability on a previous injury or unrelated incident, or misinterpret the amount or extent of work you can safely perform.
- Physical examination. The doctor will evaluate your general physical appearance, abilities, and behavior throughout the course of the exam. He or she may ask you to perform some motions or exercises to determine the limits of your physical abilities.
- Questions. The patient should be prepared to answer questions about their medical history, medical treatments, and current physical condition. These questions may range from simple inquiries to a detailed list of symptoms, any of which may be manipulated and used against the patient. For example, when asked “How are you feeling?” many patients will respond that they are “fine”—but of course, they are suffering from a severe injury. In some cases, an interview can turn hostile, especially if the doctor accuses the patient of lying or misrepresenting the effects of the injury. Anything you say can be used in the IME report, even if the doctor was steering you in the wrong direction.
How an Attorney Can Protect Your Right to Benefits During an IME
Patients who bring an attorney to the IME have a definite advantage over those who attempt to attend the IME alone. Not only can your attorney protect you during the exam, he or she can also challenge any information in the final report that is inaccurate or harmful to your claim.
A maritime injury attorney can be invaluable during an IME by:
- Taking notes. Your lawyer will take note of what questions the doctor asks, the tests performed, and how long each one takes while you can focus on your responses.
- Examining source documents. Your attorney can ask to see which documents are being used for the doctor’s reference, which may be relevant if the doctor is reading questions specifically posed by the insurance company.
- Speaking on your behalf. Your attorney can intervene if you are asked any misleading questions or are asked to perform any physical activities that cause pain or discomfort.
- Timing the procedure. The amount of time spent examining the injury and the total duration of the exam can have a bearing on the doctor’s credibility. For instance, a medical opinion based on an examination that took seven minutes may not be as accurate as the opinion of the doctor who has been treating you for several months.
- Questioning the doctor’s methods and conclusions. While the doctor is observing you, your attorney will observe the doctor, taking notes on any specific conduct that could be considered unprofessional.
- Evaluating the report. Your attorney can request a copy of the final report and review it for accuracy and completeness. In addition, the attorney can request additional information about the IME doctor, including his or her curriculum vitae, specialties, and relationship with the insurance company.
If your employer or insurer has requested that you attend an IME, you should contact us as soon as possible to protect your right to benefits. Call (800) 362-9329 today to speak with a maritime lawyer at Hofmann & Schweitzer or download your complimentary copy of Are You a Seaman Injured in a Maritime Accident? Know Your Rights today.