Waiting for an Independent Medical report; delaying benefits.
When you are pursuing your claim for disability benefits against your employer, you may be asked by them to have an independent medical examination (IME). The IME can be used to evaluate the extent of your injury, as well as issues of causation of the injury. But the IME report should be used properly for the purposes of assessing your claim, and not to delay your treatment or payment.
We were recently asked about this scenario, by an employee wanting to know whether there was a time limit for the physician doing the IME to submit the report from the exam. This employee had seen the physician 40 days ago, and still had not seen a report. The delay in delivering a report of the exam was preventing scheduling further medical treatment, and receiving disability pay.
Though there is no definitive time limit for producing a report (other than at least 48 hours before the arbitration hearing), the physician is required to deliver the report “as soon as practicable.” This means that there should not be any unreasonable delay or gamesmanship, though 40 days sounds like just that. But you’re not without recourse.
First, if you find out that your employer received a copy of the report, and you have not, the physician may be barred from testifying at the next hearing. Second, if the time seems like it is getting curiously long, there may be something going on, and your lawyer should be on top of the situation. He or she can bring a 19b petition for an emergency hearing on the matter. This remedy is available when benefits or medical bills are unpaid because of such a delay. Also, a subpoena may be issued by your attorney to compel production of any reports or records that will be used as evidence in the case.
The longer the delay, the more suspicious I become. Sometimes it is just a lazy or busy doctor, but since many IME physicians churn these things out as a huge source of income, when the report doesn’t arrive quickly, it leads me to believe the doctor found against the insurance companies. Doctors make so much money off these exams and want the insurance company business that they will often issue preliminary reports within 24 hours. We find that the insurance companies typically turn those over right away.
So while there is no “set in stone” time limit for an IME report to be submitted, you don’t have to just sit and wait while you are losing treatment or benefits. A good workers’ compensation attorney can help remedy the situation. And by the way, if you have an IME, go to trial and the IME report is not presented, the Arbitrator is allowed to presume that the report would have been in your favor.
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