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Independent Medical Examination – Know Your Rights!

Why Would the Insurance Company Require an Independent Medical Evaluation (RIME)?

The insurance company from time to time can require that you attend an independent medical evaluation for the following reasons: (a) If you have a work injury (b) If you are treating and receiving medical care and (c) If you are receiving lost wage benefits.

Why Would an Adjuster Need to Send a Person for an Evaluation?

Most of the time when an adjuster is looking at the files, they will see how long one of the injured workers has been treating and that the person is not improving.  The adjuster would send a person to a RIME to get another opinion on why they are not improving and what they need to do to have them improve.  In other words, they want to get the claim closed regardless of whether the person gets better or not.  In their opinion, closure means better.

Another reason why the insurance company may be sending you to another doctor is because there is proposed treatment, surgery, injections, other therapy, etc. that the treating doctor is recommending.

The Reason the Evaluation is Called Independent

The only reason the evaluation is called independent is because that doctor theoretically has no business connections with the treating doctors and, therefore, has no financial interest in whether the treatment is provided.

The bottom line is that 95% of the time if the insurance company is sending you to a RIME, it is a problem and you need to be prepared.

The Five Most Common Questions about an Independent Medical Examination

  1. Do You Have to Go? Yes, you must go.  Even if they sent you to another doctor a month ago or two months ago, even if it is their company doctor who is recommending the treatment, they can still send you to another doctor.

 

  1. What Happens if You Do Not Go and Refuse? The truth is the insurance company can pretty much make you go.  They can stop paying your lost wages, stop paying for any medical benefits or pay for anything.  They can also get an order from a judge to compel you to go.  If you violate the order, you could theoretically pay a penalty up to $500 to $1,000 a day, although I have never personally seen that.  The bottom line is if you do not go to that appointment, your claim is over and done.

 

  1. Will You Get Compensated For Your Time Off Work? If you are already off work, then that is not as much of an issue.  If you are working and going to the IME is going to require you to take time off work, the rule states that you will be compensated $75.00 for your missed time at work.  You will receive the $75.00 whether you make $500 a day or $5.00 a day.

If you must travel, the insurance company will pay for your travel.  For example, if you are in Florida and you must come back to Colorado, you will receive travel compensation.  Travel compensation includes air travel.  The rule is that if you travel more than four hours to attend the IME, you are going to receive a food allowance.  If the IME is something where arguably you would have to stay overnight, you are going to receive hotel compensation.

 

  1. Can You Bring a Chaperone? Your family members may attend, but more than likely the doctor will not allow them in the room.  If you are going to bring them, they need to be quiet.  That means that they cannot be talking.  You must be the one who is doing the talking.

It is true that that the doctor performing the evaluation could say no it is going to be just you and me.  Absent extraordinary circumstances, we are not going to get that overturned.  Furthermore, the carrier could say that you will have to pay for the evaluation because you canceled the appointment, or the doctor canceled because you refused.  Again, absent extraordinary circumstances, we cannot compel an IME physician to allow anyone in the room with you.

The exception is that should you choose to take on the personal expense, you can have a licensed medical physician in the room.  Depending on the circumstances, to have a doctor attend the appointment can cost between $1000 to $2,000.  In our opinion, it is extremely worth it because that doctor who is present can see how the evaluation is performed.  Often, the evaluating physician will change a little bit in terms of how they do things.  They cannot suddenly say you were acting in a way that you were not, because now there is a third party who is going to be able to testify that it is not true.

If you receive an IME notice and you want a doctor with you, you need to contact us immediately so that we can start making the arrangements.  I would say that 9 times out of 10, it is going to be helpful to you and worth the expense.

 

  1. Can I Secretly Record the Doctor? The evaluation is going to be recorded anyway.  The adjuster is going to obtain a copy of that recording and hear everything the doctor said and hear what you said.

The law is that the IME physician is required to record the exam.  You need to make sure that the visit is being recorded.  You should be stating things that are going on if they happen.  A classic example is if you are being asked to raise your arm and you feel the doctor is pushing your arm up, you need to say, “Doctor, would you not push my arm?”  You say things that may not be apparent by just listening to the exam.

The good news is that the exam is recorded by law and the doctor must make that recording available.  You can always personally record conversations in Colorado if one person, typically you, are aware of it and consents, but it is not necessarily needed in IMEs since it is recorded anyway.

Pay Attention to this Reg Flag!

Hopefully, today’s blog will convince you that if you have a work injury and you are being sent to a medical evaluation by the insurance company, that is a huge red flag for you to hire an experienced attorney who handles Colorado work injuries.

Kaplan Morrell Helps Injured and Disabled Workers Throughout Colorado – Independent Medical Examination – Know Your Rights!

As always, if you or anyone that you love is injured in Colorado, let them know about Kaplan Morrell.  We are a law firm that has been helping injured and disabled workers since 1997.

The Attorneys at Kaplan Morrell Fight Hard for Our Clients

We would be happy and thrilled to help you.  Please give us a call at (970) 356-9898.  You may also visit us on our website at kaplanmorrell.com.  As always, the initial consultation is completely free.