Last month my workers’ compensation topic focused on treating with your own doctor after a work injury. This month we’re going to talk about doctors again but with a different twist. I’m talking about the “independent” medical examiner. Who is he and what is his role in your workers’ compensation case?
Section 314 of the Pennsylvania Workers’ Compensation Act authorizes a workers’ compensation insurer to direct an injured worker to submit to a physical examination by an appropriate health-care provider at any time after a work injury.
Insurers have come to call these directed exams “independent” medical exams. Make no mistake, there is nothing independent about this exam. This is a DEFENSE medical examination where the workers’ compensation insurance company is directing you to a hand-selected doctor with the goal of securing a specific opinion necessary to challenge your claim (opinions such as, “the worker is not really injured” or “the worker is not as injured as his own treating doctor says she is” provide the insurer with the ammo they are looking for to challenge your case).
“Independent” medical examiners are hand selected and coached behind the scenes by the workers’ compensation insurer to provide specific opinions and recommendations in an effort to help the insurer save money. These medical examiners are well-trained and creative in their approaches. Not to be overlooked, in most instances, independent medical examiners are making tens of thousands of dollars per year performing examinations for insurance companies. Business only stays booming if the doctors continue to give the insurers the opinions they seek.
Unfortunately, some workers’ compensation adjusters will lead injured workers to believe that the “independent” medical examination is for a second opinion. This is particularly true when surgery or other expensive treatment is being recommended. Again, make no mistake about it, if the insurance company is directing you to a specific doctor and calling it an “independent” medical exam, you are being set up to have a legal challenge brought to your ongoing eligibility for workers’ compensation benefits. You need someone in your corner to guide you through this process.
If you’ve suffered a work related injury and your insurance adjuster or nurse case manager has been discussing independent medical exams, it’s time to get a lawyer on your side who can give you a full and accurate explanation as to how such an exam could impact your legal rights. Contact our office and speak with an attorney who specializes in workers’ compensation claims at the first sign of the so-called “independent exam.”
Michael A. O’Donnell, Esq.
O’Donnell Law Offices
267 Wyoming Avenue
Kingston, Pa. 18702
Certified as a specialist in the practice of workers’ compensation law by the Pennsylvania Bar Association Section on Workers’ Compensation Law as authorized by the Pennsylvania Supreme Court.