How Florida IME Works for Workers Compensation

If you got injured at work, then you might be able to claim workers’ compensation. But when there’s a dispute on your eligibility for workers comp benefits, you’ll most likely have to go through an independent medical examination (IME).

Since different states have varying workers comp laws, the regulations surrounding IMEs also differ. And understanding how IME works in your state is essential in winning your workers’ comp case.

Here’s a quick guide on the Florida IME rules and processes for workers’ compensation:

What is an IME?

Florida Statute section 440.13 defines independent medical examination (IME) as:

an objective evaluation of the injured employee’s medical condition, including, but not limited to, impairment or work status, performed by a physician or an expert medical advisor at the request of a party, a judge of compensation claims, or the department to assist in the resolution of a dispute arising under this chapter

To put it simply, IME is an impartial medical assessment conducted to settle any dispute arising from workers comp claims. It’s performed by licensed medical practitioners at the request of any of the parties in a workers comp case. Aside from the injured worker’s medical condition, their impairment level and capacity to work will also be evaluated.

The results of an IME exam play a very important role in the outcome of a workers comp claim. In some cases, it becomes the primary basis of a judge’s decision whether to grant or deny your benefits.

Despite its name, however, IMEs aren’t really that independent nor objective. Since insurance providers are allowed to choose the IME examiner, they often exploit the exam for their own gain.

Let’s say the IME doctor concluded that your injury is caused by a pre-existing condition rather than workplace factors. The insurance carrier can use this information to argue that your injury isn’t work-related. The judge may agree with them too. This is why it’s essential for injured workers to know what their rights are when it comes to IME.

Florida IME Rules and Processes

Selecting the IME Doctor

As I’ve said, state laws on independent medical examinations tend to vary. In some states, the IME doctor is assigned by the judge from a random list of licensed medical practitioners. But in general, it’s the employer or insurance company that gets to choose the IME doctor.

In Florida, however, both the injured employee and the insurance carrier have the right to request an IME. As such, they both have the right to choose who will conduct the IME depending on who made the request.

The Florida statutes further provide that the requesting party should inform the other of their choice within 15 days after the exam. Failure to do so shall render the result of the IME invalid. As such, the requesting party cannot present it as evidence in court.

Note, however, that both parties are only entitled to one IME per accident and not per medical specialty.

Scheduling the IME

If the insurance company is requesting the exam, they may contact the injured worker directly to schedule the IME. But they must do so in writing at least seven days before the examination date.

If you are not available on the scheduled date, you must inform the examiner at least 24 hours before. Failing to appear at your scheduled IME without any valid reason will prevent you from recovering compensation for any period during which you refused to submit to such an examination. Plus, you’ll have to reimburse your insurance provider 50% of the cancellation or no-show fee.

Validity of the IME Doctor’s Opinion

Regardless of who requested the IME, the independent medical examiner should only render an opinion within their area of expertise.

So if the IME doctor is a licensed orthopedist, their opinion is only valid if it concerns your bone injury. They cannot opine on your psychological trauma or any other bodily injuries you may have.

Changing the IME Doctor

Sometimes, the opinion of the IME doctor you choose is different from what you expected. So you may want to switch to a different medical provider. In Florida, this is only allowed if:

  • the examiner’s qualification doesn’t match the aspects of the worker’s injury or illness that is material to the claim or petition for benefits;
  • the examiner no longer practices in the specialty relevant to the injured worker’s condition;
  • the examiner isn’t available due to injury, relocation  outside a reasonably accessible geographic area, or death;
  • the parties agree to change the examiner

Who Pays for Your IME in Florida?

According to Florida statutes, the party who requested the IME should pay for all the expenses related thereto. This includes any necessary medical diagnostic tests, doctor’s fees, and other relevant costs.

However, if the injured employee wins the case and is granted the benefits after they’ve gone through an IME, the exam and all related expenses shall be paid for by the employer or insurance provider. But attorney’s fees incurred in connection with a delay or opposition to an IME are not refundable.

VICTOR MALCA – Florida Workers Compensation & Social Security Disability Attorney

Victor Malca P.A. has over 27 years of litigation experience in Workers Compensation and Social Security Disability lawsuits. His experience and continued success when fighting for his clients puts him among the most trusted workers’ compensation attorney’s in Florida. He specializes in representing injured workers on compensation benefit cases and disabled individuals claiming lost social security disability benefits.

Book a free consultation today. Our unwavering advocacy for employee rights and privileges are recognized by our past clients across South Florida.

About The Author

Judy Ponio is a writer and editor for the Victor Malca Law P.A. website and blog. She enjoys helping people in need with questions about social security disability and workers compensation law. She has a passion for helping those in need and the elderly with accurate legal information that can make a positive difference in their lives.