Independent Medical Examinations & Impairment Ratings
Injured workers in PA should know some of the procedures they may face during their claim. Certain procedures can determine the extent of the injury, the ability to work, and the compensation received. Here, we will cover Independent Medical Examinations (IMEs), expert interviews, and Impairment Rating Evaluations (IREs).
What Does Independent Medical Examination (IME) Mean?
An Independent Medical Examination (IME) refers to a medical evaluation performed by a doctor chosen by your employer or their insurance company. An IME aims to obtain an objective assessment of the medical condition following a work-related injury. Research shows these exams tend to favor the employer much more than a treating physician.
Many stakeholders report these examinations as barely an exam and not independent. But, employers have the right to request that injured workers undergo an IME at a reasonable time and place. This exam may allow the employer to dispute the extent of the injury and any ongoing medical treatment. It also allows them to challenge the worker’s medical restrictions.
@thwesq Replying to @laurencepatterso8 unfortunately, the financial incentive for these doctors seems too far out weigh any moral compass they may have had. Independent medical exams are not independent, and they are barely a medical exam. #workersrights #workerscomp #lawyer #workinjurylawyer #workinjury ♬ original sound – Tom Wing | Workers Comp Lawyer
Why Does An Employer Request An IME?
Employers often request an IME to gather a second opinion about the medical condition from a friendly party. An IME can provide evidence on the diagnosis, the current treatments, and the prognosis for returning to work. This can save the employer money on claims. IMEs help employers to challenge parts of an employee’s claim.
What If I Refuse To Attend An IME?
Refusing to comply with an order for an IME can lead to serious consequences. The Pennsylvania Workers’ Compensation Act addresses this. If you miss an IME without reasonable cause, you risk losing your benefits during this period. This means they could suspend wage loss and medical benefits.
How Often Can My Employer Request An IME?
The frequency of IMEs can vary. Typically, employers may request an IME every six months. This can depend on the circumstances of the case and the discretion of the Workers’ Compensation Judge (WCJ).
May I have My Own Doctor Present During An IME?
Yes, you have the right to have your own healthcare provider there during the IME. However, your doctor’s role remains limited to observing the exam. They cannot interfere, videotape or audiotape, question the examiner, or help you in responding to questions. Your lawyer may hire a nurse to attend the exam as well.
Understanding Expert Interviews
What Happens At A Vocational Expert Interview?
Vocational expert interviews assess the injured worker’s earning power when receiving workers’ comp. They look at their ability to return to work. They also determine the type of work they can perform, given the injury. The insurer can require the worker to submit to an interview with a vocational expert.
Why Conduct Vocational Expert Interviews?
The main purpose of a vocational expert interview involves assessing the worker’s earning capacity. They consider the worker’s education, work experience, skills, and current labor market conditions. Then, they will determine the types of jobs that might suit the injured worker.
The findings from the vocational interview can impact the continuation or modification of workers’ comp benefits.
What Qualifications Does A Vocational Expert Have?
Vocational experts must adhere to the criteria set forth by the Bureau of Workers’ Compensation. They must have a Commission on Rehabilitation Counselor Certification and one year of experience analyzing labor market conditions. Or, a bachelor’s degree and work under the direct supervision of someone with these qualifications.
What If I Refuse To Attend A Vocational Expert Interview?
Refusing to attend a vocational expert interview can result in the suspension of benefits. The WCJ has the authority to enforce attendance at these interviews. They can also suspend benefits for failure to comply without reasonable cause.
Impairment Rating Evaluations (IREs)
What Does IRE Mean?
An IRE refers to a medical assessment used to determine the extent of permanent impairment from a work injury. An IRE aims to establish the degree of the body impairment and classify the disability status.
IREs must use the sixth edition of the American Medical Association Guides to the Evaluation of Permanent Impairment. The results of an IRE can impact the duration and amount of workers’ comp benefits.
How Does An IRE Affect Disability Status?
The IRE’s outcome determines whether the disability status remains classified as totally disabled or changes to partial disability. If the impairment rating hits 35% or higher, total disability benefits will continue.
If the impairment rating is less than 35%, the status will change to partial disability. This change means receiving partial disability benefits. While the name of the benefit changes, the amount of the benefit stays the same. However, an injured worker can only receive partial disability benefits for a maximum of 500 weeks.
What If I Disagree With The IRE Results?
If you disagree with the results of an IRE, you may be able to appeal the decision. This would involve filing a petition for review with the Bureau of Workers’ Compensation or hiring your own expert.
Reaching Maximum Medical Improvement (MMI)
What Does MMI Mean?
Maximum medical improvement (MMI) refers to a vital point in the recovery. It means the medical condition has stabilized and will likely not improve that much with further treatment.
An injured worker must reach MMI before an impairment evaluation. It can also impact decisions regarding your workers’ compensation claims.
Understanding the Editions of the Guides
The American Medical Association Guides to the Evaluation of Permanent Impairment, often referred to simply as the “Guides.” They serve to assess the extent of an injured worker’s permanent impairment.
Different editions of the Guides appear over time, each incorporating updated medical knowledge and assessment techniques. The sixth edition, currently used for IREs in PA, includes comprehensive criteria for evaluating various types of impairments and determining the overall impairment rating.
Wrap Up
Know your rights. For help with your workers’ comp case, consult with a workers’ compensation lawyer. An experienced lawyer can help secure the benefits you need to support your recovery and future well-being. For a free consultation, reach out to our offices 24/7 at (215) 609-4183.
