Workers Compensation And The Myth Behind The Independent Medical Examiner

A workers compensation attorney Riverside explains that workers compensation happens to be the oldest form of social insurance in America and was introduced to the country over a hundred years ago. It was put in place to protect employees who were unable to work because they were injured on the job, and payment is made by the company's designated insurance carrier generally within 72 hours. This was so that the injured party received immediate funds in order to cover medical expenses and lost wages whilst in recovery. It also meant that the victim didn't have to go through any costly and timely litigation processes before they received funding.

It is fair to say that although reforms are in place, workers compensation hasn't changed much in this time and is now considered pretty archaic by many who are caught up in the system. A prime example of this is when it comes to Independent Medical Examiners (IME'S).

What exactly is an IME? A Riverside workers compensation lawyer explains...

An independent medical examiner is a professional practitioner who is there to examine injured parties after the event of an accident in the workplace, and from this give their medical opinion as to the type and severity of injury that a patient has. From these findings the insurance carrier will put in place payments based upon this examination.

Sounds above board, so what exactly is the issue?

In reality an independent medical examiner is all but independent and in many cases is picked and paid for by the insurance company. What this means is that the insurance company if they so wished could easily influence the decision of the examiner so as to play down the injuries of victims in order to decrease payments and payment times, or in some cases, fail to make payments at all. If you believe that you have either had a justified claim underpaid or denied, then don't just keep quiet. Instead be aware that a team of Riverside employment law attorneys can help you to revive the full and fair claim that you deserve.

Other issues

Many disputes have come to light whereby upon authority of the IME, the insurance carrier has ceased payment because the examiner has decreed that the patient is fit enough to return to work. In reality the patient may not feel that they are actually fit enough to return to work, and by doing so may cause more serious harm. They may feel forced back to work in order to start earning money because compensation payments have stopped. This is something that an experienced team of workers compensation lawyers have to deal with on a regular basis and as a result will call upon the services of a 'real' independent expert to present their medical findings to the representing attorney. If the lawyer is successful, the workers compensation review board can instruct the insurance carrier to continue making payments to the injured party until such times as they are truly fit and well.

So do I have to be examined by an IME?

The answer to this is that you can select your own practitioner if you so wish, and therefore don't have to have an initial examination by an IME. However this is on the proviso that the name and address of the practitioner is given in writing at least 30 days before any accident occurs. With this in mind it is always advisable to notify your employer of your doctor's details as soon as you can. If you express that you would like to be examined by your doctor after the event of an accident and you haven't notified your employer, then the insurance company will elect for you to still be examined by the IME

IME bias towards insurers

There has always been a concern that there is indeed independent medical examiner bias towards the insurance companies. However, an interesting report was carried out in 2004 by the Department of Consumer and Business Services in the state of Oregon who commissioned a study to look at the working practices of IME's. In it they stated that there is indeed growing evidence to suggest that there is a physical bias towards insurance companies by those IME's who work with them. Not only were their findings expressed by the injured worker or the legal teams representing them, but rather surprisingly, 53% of the IME's themselves responded to the survey saying that there was indeed a level of bias. A Riverside workers compensation lawyer states that this data only reiterates what has already been thought previously.

Clearly not all IME's are bias and not all insurance carriers are crooked, but it is clear that workers comp does need some sort of strong reforms in place. In the meantime, be rest assured that there are some experienced Riverside County workers compensation attorneys who can step in to help should the need arise.