When a work-related injury or illness occurs, Oregon and most other states have a workers’ compensation system to provide the worker with benefits. These include payment of the cost of medical treatment and care and payment of wages lost from being unable to work while recovering.
A claim for benefits is filed with your employer or with the insurance company providing the workers’ comp coverage policy. It is a complicated system that can become even more so if you are unfamiliar with the rules and procedures used to process a claim for benefits. For example, you may be notified by an insurance company of an independent medical examination, or IME.
A Bend, Oregon, workers’ compensation lawyer can guide you through each step of the claims process, including medical examinations. To help get you started, here is what you need to know about IMEs and how to prevent them from jeopardizing your claim for workers’ comp benefits.
The process to file a claim for benefits
The workers’ compensation laws of your state have established specific procedures for handling work-related injury or illness claims for benefits. For example, the process to file a claim in Oregon includes the following:
- You must notify your employer right away by completing an injury report form.
- Your employer must submit the report to the workers’ compensation insurance carrier within five days.
- You must obtain medical treatment and have the doctor submit a medical provider’s form within 72 hours to the workers’ comp insurance company.
- The insurance company must accept or deny the claim within 60 days from when you gave notice to your employer.
Although it has access to information from your medical provider, the insurance company has the right to ask for an IME.
Independent medical examinations
An insurance company may decide that it needs an evaluation of your medical condition by a doctor or other healthcare professional who is not currently treating you. Insurers generally request an IME for the following reasons:
- To provide a diagnosis of the condition and recommend a plan for its treatment.
- To determine whether a medical condition is work related and eligible for compensation benefits.
- To determine whether a claim should be closed based on a worker’s current medical condition.
An insurance company may require that you attend up to three IMEs. If you fail to attend a scheduled examination, the insurer may suspend benefit payments until you comply.
Mistakes happen, so if you miss an appointment for an IME, a Bend workers’ compensation attorney can arrange to have it rescheduled to avoid an interruption of benefits or to restore benefits that have been suspended.
What rights do I have when scheduled for an IME?
Although you cannot decline an IME, you do have certain rights, including:
- If traveling to the IME location chosen by the insurer creates an undue hardship or your medical condition prevents it, you may ask for a different location or that it be delayed until your medical condition improves.
- The insurer must reimburse you for expenses incurred due to the IME, including mileage, meals, and childcare.
- The healthcare provider conducting the IME may not subject you to injections or other invasive procedures without your consent.
Keep in mind that the role of the healthcare providers conducting IMEs is to evaluate and offer an opinion about your medical condition. They do not treat you.
What to do during an IME?
Your workers’ compensation attorney will prepare you for an IME, but here are a few tips:
- Be honest when answering questions posed by the healthcare provider.
- Avoid downplaying or understating the effects of your medical condition.
- Do not exaggerate when describing your medical condition or how the injury or illness occurred.
- Do not consent to any invasive procedures at the IME without first consulting with your workers’ comp attorney.
- Do not sign any documents at the IME unless they have been reviewed by your lawyer.
- Assume that whatever you say to the person conducting the IME will become part of the report submitted to the insurance company.
The person conducting an IME is there to evaluate your medical condition on behalf of the insurance company.
Speak with your Bend workers’ comp lawyer
If an IME leads to a denial or closing of your claim, your Bend workers’ compensation attorney will discuss options available to you. For example, your attorney may appeal the denial and ask for a worker-requested medical examination conducted by a physician selected by the Workers’ Compensation Division. The request must be made within 60 days, so contact your attorney right away.