Do You Need To Go To A Second IME?

A reader of the blog had a very interesting situation.  He had been hurt at work and right after he was injured, the insurance company sent him for an IME.  That hired gun doctor said he was fine and could go back to work.

Fortunately this injured worker was smart enough to seek out his own doctor.  That physician had a MRI ordered which showed a major injury.  As a result, the work comp case was accepted and they paid for his medical care.

Fast forward 10 months later and the worker is still getting medical care.  Now the insurance company wants to send him for another IME.  The question he had is does he have to go?

While insurance companies can’t just doctor shop until they get the opinion they want, they are allowed to ask for IME updates.  In a case like this, we would advise him to go to the exam, but before that happens we’d reach out to the insurance company or their lawyer to set up parameters.

The new exam should be limited to treatment from when this guy was last seen for the IME up until now.  He can address the MRI, the current treatment plan and the workers’ physical condition.

On the flip side, we’ve seen in the past where insurance companies don’t like what their report says or they are trying to manipulate your medical care, so they send you to another IME within a couple of months of the first one.  This usually shouldn’t happen. The exception would be if it’s a follow up after something like an EMG. But usually they can just review the records and shouldn’t need to see you.

I do think the insurance company in this case is wasting their money.  Their IME doctor has lost his credibility by saying that the worker was fine.  The MRI proved that he was very wrong. Any determination now that the worker is fine will be met by an Arbitrator with skepticism.

So most likely this is nothing to worry about.  I do though like that this reader is looking out for himself. You should never just roll over and do what the insurance company wants without asking questions first.  They will push you around if you let them, so don’t let them.