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How do you get an independent medical examination (IME) in your workers’ compensation case?
If the doctor that your employer sent you to is not providing effective treatment, is not providing an accurate diagnosis, or has grossly underestimated your disability and impairment ratings, can you just request a second opinion from an independent doctor that was not chosen by your employer?
The insurance company can. SC law permits your employer to request an “independent” medical examination by a doctor of their choosing if they don’t like the initial results. You can also have a doctor attend, but only if you are willing to pay for your doctor out of your own pocket.
Below, we will discuss independent medical examinations in SC workers’ comp cases, including:
An IME is an “independent” medical examination conducted by a doctor who is not the employee’s primary physician.
The purpose of an IME is to provide an unbiased opinion regarding the extent of the employee’s injuries, the course of treatment that should be pursued, and the employee’s ability to return to work.
In South Carolina, SC Code § 42-15-80 of the Workers’ Compensation Act allows employers to request an IME when there is a dispute over the nature and extent of an employee’s injuries:
(A) After an injury and so long as he claims compensation, the employee, if so requested by his employer or ordered by the commission, shall submit himself to examination, at reasonable times and places, by a qualified physician or surgeon designated and paid by the employer or the commission.
Independent medical examinations are common, and the insurance company is likely to request one any time a workplace injury is going to cost them a substantial amount – to attempt to challenge the extent of the injury, the cause of the injury, the disability and impairment ratings, or any fact that could result in a lower settlement amount for the employee.
The role of IMEs in workers’ compensation claims has been the subject of much debate and controversy. Insurance companies would argue that IMEs are necessary to prevent fraudulent claims and to ensure that employees receive appropriate treatment. Many employees and workers’ compensation attorneys would tell you that IMEs are biased and serve as a tool for insurance companies to deny valid claims.
Are “independent” medical examinations biased? Who is paying the doctor’s bills? Not you…
Do you think that a doctor may have a valid concern that they will no longer receive referrals from the insurance company if their medical opinions are favorable to the employee (and cost the insurance company money they don’t want to pay)?
When does the insurance company request an IME? Only when the first medical opinion is not favorable to them…
If an employee unreasonably “refuses to submit” or “obstructs the examination,” they will no longer have a right to benefits and the Commission may dismiss their workers’ compensation case:
If the employee refuses to submit himself to or in any way obstructs the examination requested by and provided for by the employer, his right to compensation and his right to take or prosecute a proceeding under this title must be suspended until the refusal or objection ceases and compensation is not payable at any time for the period of suspension unless in the opinion of the commission the circumstances justify the refusal or obstruction.
Note that, in some cases, a refusal to submit to an examination can be “cured” and benefits may be reinstated.
If the insurance company doesn’t like the results of your initial medical examination, they can order an “independent” examination by a doctor of their choosing.
Can you do the same?
If you have your own doctor “present at the examination,” however, you must pay for your doctor on your own.
Although most interactions with doctors are confidential and covered by the doctor-patient privilege, this does not apply to workers’ compensation examinations:
A fact communicated to or otherwise learned by any physician or surgeon who may have attended or examined the employee, or who may have been present at any examination, is not privileged, either in hearings provided for by this title or any action at law brought to recover damages against an employer who may have accepted the compensation provisions of this title.
Both the insurance company’s “independent” doctor and your own physician, if they attend the independent medical examination, can be compelled to testify about their observations and findings in your workers’ compensation case.
Once the employer (their insurance company) is paying benefits pursuant to a final order, they cannot request an independent medical examination in an attempt to modify the benefits (see Risinger v. Knight Textiles).
Your Myrtle Beach worker’s compensation lawyer on the Axelrod team will help you to file your claim, obtain a second medical opinion when appropriate, and represent you before the workers’ compensation commission for any hearings and appeals.
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