What is an IME – do I have to go?
An Independent medical examination (IME) is an evaluation performed by a doctor picked by the insurer processing your claim. The insurer will choose the doctor and pay for the exam. Review the IME physician, worker, defense attorney, worker attorney, and workers’ compensation doctor surveys result for shocking information about IMEs; IME study report. The insurer may send you to an IME up to three times per claim opening – if your claim is closed then reopened the IME count will reset.; however, the insurer may request an additional IME to the Director. Your IME may have more than one doctor (called a panel exam), but this will still only count as one IME evaluation. Bring a picture ID, and if requested, a copy of your medical records, diagnostic imaging, list of medications and doctors you have seen for your work injury. You may use a video camera or tape recorder to record the exam only if the tor(s) approves. The doctor will examine you, but will not provide you with medical treatment. You have the right to tell the doctor to stop the exam if it is causing you too much pain. In a report to the insurer, the doctor will answer questions requested by the insurer. A copy of the IME report will be sent to your workers’ compensation doctor (attending physician) for his/her opinion (concurrence) – review report outcome with your doctor and learn their opinion. You can obtain a copy of the IME report by sending your request in writing to the insurer. Go online to complete the WCD survey or to voice your complaint(s) about the IME doctor/process.
Can I have someone in the room with me during the IME exam? You have the right to have an unpaid observer with you (i.e. spouse, partner, or friend, but NOT attorney) – complete the IME observer form and provide a copy to all doctors’; however, the doctor performing the psychological IME may deny your request for an observer to be present during evaluation. An observer cannot participate in or interfere with the evaluation. Keep in mind the IME doctor may ask you sensitive questions that could be embarrassing, so choose your observer carefully.
Who pays for the IME? The insurer will pay some of your expenses incurred for you to attend the IME (i.e. car mileage, child care, and some meals (daily per diem), and lodging if you travel far to exam location); however, your observer or accompanying family members’ costs will not be covered by insurer. The insurer will send you a form for you to request repayment of your expenses. Submit this form as soon as possible, and if desired, ask for advance payment prior to IME appointment.
Can the IME doctor perform an invasive procedure (the body is entered by a needle, tube, scope, or scalpel) on me? The doctor must explain the risks of the procedure to you. You have the right to refuse an invasive procedure – your refusal will not affect your right to workers’ compensation benefits. Complete the Invasive Medical Procedure Authorization form, marking “Yes” or “No,” and give it back to the doctor; you will be supplied a copy, the original will be sent to the insurer.
Do I have to go to an IME? Yes – If you cannot go to the IME appointment, contact the insurer immediately. If you do not attend and supply a good reason, the Workers’ Compensation Division (WCD) may allow the insurer to stop paying your benefits (i.e. medical treatment, time loss, and permanent disability). Also, the WCD may fine you $100 if you do not attend the exam – insurer would take the $100 from any future benefits.
What if the IME location is hours away from my home? If you object to the location of an IME, call/write the insurer to discuss location options. Keep in mind, there are few IME location options outside of Portland Metro area. If you are unable to reach arrangement with insurer and want the WCD to formally review the location chosen by the insurer, you must ask the WCD to do this within six business days from the postmarked date that the appointment notice was mailed to you by the insurer. Detail your reasons on why your object to the IME location. Your objection must be related to the location of the exam and due to a medical reason for not being able to travel to the exam or you must be able to demonstrate another good reason that the travel is unreasonable. The medical reason does not have to be related to your work injury, but the WCD must be able to verify with your doctor that you are restricted from traveling to the exam, and that alternative methods of travel will not overcome those restrictions. If you cannot attend the IME for any other reason besides the location of the exam, you should immediately call the insurer as he/she may be able to make other arrangements for your IME exam (i.e. transportation assistance). The WCD will review your reasons and either help you and the insurer reach an agreement about the location or issue an order stating whether the location is reasonable for the required travel. If the WCD issues an order that the required travel is reasonable, you must attend the exam or your benefits may be suspended. If the WCD issues an order that the required travel is not reasonable, the insurer must reschedule the exam, if they still want you to attend an IME; if your claim has not yet been accepted or denied, the insurer will be allowed 90 days instead of 60 days to either accept or deny your claim.
You may contact WCD by phone, fax, mail, or in person:
800-452-0288 or 503-947-7585; 503-947-7725 fax; Workers’ Compensation Division, Attn.: Sanctions Expedited Review
P.O. Box 14480, Salem, OR 97309-0405; or in person second floor of the Labor and Industries Building 350 Winter St. NE, Salem, OR 97301.
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