Understanding How Medical Evaluations Impact Workers’ Comp

Understanding How Medical Evaluations Impact Workers' Comp

If you sustain an injury or develop a medical condition as a result of your work, you have the right to file a workers’ compensation claim through your employer to protect yourself and your family from financial hardship.

While the vast majority of workers’ comp cases are legitimate, the insurance provider still has the right to investigate your claim’s validity. In many cases, this investigation includes a mandatory independent medical examination (IME).

An IME doesn’t negate the need to seek medical attention for your injury through your regular provider or another doctor. But since these exams can impact your benefits, it’s important to understand their role in the workers’ comp system so you can protect your rights and interests.

The Role of Independent Medical Examinations (IMEs)

IMEs are frequently requested by insurance companies like SAIF as part of the workers’ comp claims process in Oregon. These exams take place after a worker has filed a claim and seen a doctor for treatment, and the purpose is to validate the legitimacy of the claim.

While you have the right to seek medical treatment from the physician of your choice for your injury, IMEs are performed by doctors who are authorized by the Department of Consumer and Business Services, and they cannot be involved in your treatment.

Although they’re scheduled and paid for by insurers, IMEs are mandatory. Failure to attend an IME can result in the suspension or loss of your benefits. If one is scheduled, it’s essential that you comply with the request.

The Impact of IMEs on Workers’ Comp Claims

woman rubbing her temples

The opinions provided in workers’ comp medical evaluation reports are used to make decisions about claim approvals and denials.

It’s important to be aware that insurance providers often choose doctors selectively in an attempt to avoid providing you the benefits you deserve. The system isn’t fair. For example, the IME doctor may try to say that your condition wasn’t actually caused by your work, but was instead:

  • The result of the natural aging process
  • Triggered by a previous injury or preexisting condition
  • Caused by another activity like hiking on weekends

While an IME can harm your workers’ comp claim even though you’re telling the truth, there’s a lot you can do to protect yourself from these kinds of tactics.

Navigating the IME Process

The best thing you can do throughout the entire workers’ comp claims process is be honest, consistent, and vocal. Speaking with an experienced Oregon workers’ comp attorney prior to attending your IME can also help you prepare for a doctor’s evaluation.

Here’s what you can expect from the IME process in Oregon:

  1. Your employer’s insurance provider has 60 days to accept or deny your claim after it’s been filed; during this period, they have the right to investigate your version of events and schedule up to three mandatory IMEs.
  2. The insurer must provide you with written notice no less than 10 days prior to the scheduled exam and inform you of the date, time, and location.
  3. You should arrive early to an IME and bring the following with you:
    • Photo ID
    • Any requested medical records
    • A current list of all medications you take
    • The names of all medical care providers you’ve seen in relation to your workers’ comp claim
  4. Invasive procedures may NOT be performed at an IME without your written informed consent.
  5. You have the right to have an unpaid observer present at the exam (provided you fill out an “IME Observer Form”), but this observer may not be your attorney.
  6. During the exam, the IME doctor will evaluate you, but they will not treat you; the expectations of a traditional patient-doctor relationship do not apply.
  7. After the exam, the IME doctor will send a copy of their report to the insurer, who will then provide a copy to your medical care provider. You also have the right to request a copy of the report directly from the insurer.

Advocating for Fair Medical Evaluations

doctor speaking with patient

The workers’ compensation system in Oregon isn’t always fair. You can’t control what your employer or their insurance company says about you or your claim. But you can protect yourself from their unfair tactics by conducting yourself with integrity at all times.

Here are some things you can do before, during, and after an IME in order to advocate for yourself, protect your rights, and give yourself the best possible chance of securing and keeping your benefits:

  • Work with an experienced workers’ comp attorney so you understand your rights and responsibilities before an IME.
  • Choose a treating physician you can trust and who will advocate for you.
  • Immediately tell your employer and treating doctor that the injury or illness was caused by your work.
  • Document everything in writing and review it often during the claims process.
  • Follow all your treating physician’s advice.
  • Arrive early to your IME and be honest and polite throughout.
  • Request a copy of the IME report from the insurer.

Ready To Secure Your Compensation? Contact RGMR for Expert Guidance!

Image of three men in suits facing camera standing in front of library wall full of books

Workers’ comp medical evaluations are never fun. Dealing with a work injury is difficult enough without the added stress of preparing for a mandatory medical evaluation and defending yourself against unfair tactics. But you’re not alone.

At RGMR, we have over 70 years of experience representing injured workers. We know the system in Oregon like the backs of our hands. We’re here to listen to your story, be your fierce advocates, and fight to ensure you get adequate compensation for your injury.

Contact us to tell us about your case and find out how we can help you secure the best possible outcome. Your initial consultation is free and we don’t charge you a single penny unless we win your case.

Adian Martin

Adian Martin (JD) is an accomplished attorney with over 25 years of experience. His goal is to use his legal expertise and passion for problem-solving to help people get the benefits and proper compensation they deserve after an injury. He received his law degree from Northwestern School of Law of Lewis & Clark College and is currently a partner at Ransom Gilbertson Martin & Ratliff. In his spare time, Adian enjoys exploring the outdoors with his dog and bicycling.

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