The IME Doctor Disagrees With My Doctor: What Do I Do?

An independent medical examination (IME) is usually requested when there’s doubt about your workers’ compensation claim. But it’s not unheard of for employers and insurance companies to use it to discredit your claim. Most of the time, they use the IME doctor’s opinion to achieve such.

This is why many injured workers often find themselves wondering, what can I do if the IME doctor disagrees with my doctor?

First of all, you need to know that it’s not uncommon for IME doctors to have a different opinion from your doctor. The good news is your claim won’t end just because of two doctors’ differing opinions. Though, this will make it harder to get your workers comp claim approved.

If you are experiencing this dilemma, here’s what you need to know.

How Does the IME Work?

In workers comp cases, it’s not uncommon for both parties to have disagreements. After all, there are a lot of factors that can affect a workers comp claim. And insurance companies aren’t exactly known for their generosity.

To settle these disagreements and bring all parties on the same page, an IME is usually conducted.

The IME is a type of medical examination where an independent third party evaluates the condition of an injured worker. In this case, the “independent third party” refers to the IME doctor.

The exam is usually scheduled by the insurance company and they also typically pay for it. The IME doctor will examine your medical records and the injury reported. They may also do a functional capacity evaluation.

When all this is done, they will then prepare a medical report containing their findings. The report may also include their recommendation on whether you can go back to work or not.

An IME doctor examining an injured worker.

IME Doctor vs. Other Treating Doctors

As mentioned, an IME doctor is an independent third party. Theoretically, they should be. But this isn’t always the case in reality.

The process of choosing an IME doctor varies from state to state. Some states give that prerogative to the injured worker. But in most cases, it’s the insurance company that gets to choose the IME doctor.

As such, IME doctors are usually under the insurance company’s payroll. Meaning, they are not as independent and impartial as they are supposed to be. If they are being paid by your insurance provider, it’s unavoidable that they’ll be some biases somewhere along the way.

The responsibility of an IME doctor is only to ascertain your medical condition. Unlike your doctor, they’re not really after your welfare.

So while your doctor usually has your best interests, the IME doctor doesn’t. On the contrary, most of them are instructed to disprove your claim.

With this, it’s inevitable that the IME doctor will disagree with your treating doctor.

What Happens When the IME Doctor Disagrees With Your Doctor?

There are two common reasons why the IME doctor may disagree with your doctor:

  • they were reviewing different or incomplete medical records
  • their treatment plans differ

Some of the most common things they disagree on are:

  • the severity of your medical condition
  • your residual functional capacity
  • what treatments are needed
  • whether or not you should go back to work

Unfortunately, an IME doctor’s opinion tends to hold a lot of weight – even if they’re a little biased. Sometimes, they may even hold more weight than that of your doctor.

If your case is taken to court, the judge will most likely believe the IME doctor more than you or your treating doctor. But that doesn’t mean you can’t challenge their opinion.

In cases like this, an experienced workers’ compensation lawyer like Victor Malca can help you. He’d been helping injured workers in Florida for the past three decades. He can help you contest your IME doctor’s opinion and get the benefits you deserve too.

What Can You Do?

If you disagree with your IME doctor’s report, here are some things you can do:

1. Prioritize Your Health

It’s not uncommon for IME doctors to recommend for an injured worker to return to work even if they’re not yet fully recovered. This is because the faster an injured worker returns to work, the lesser compensation the insurance provider will have to pay.

But if you feel that the IME doctor’s recommendation is detrimental to your health, you should tell them so. Your health should come first. If you force yourself to work when your body is not yet up to it, your injury may only get worse.

2. Disprove the IME Doctor’s Claim

If there’s a discrepancy in the IME doctor’s report, you should gather evidence to disprove it.

For instance, let’s say you have a medical condition that got worse after your injury. In some states, that should be taken into account when calculating your workers comp benefits. If your IME doctor neglected to include such detail in their report, you should write to your insurance company and inform them about it. Make sure to include evidence to prove your claim.

3. Discredit the IME Doctor

Most states have stringent requirements when it comes to choosing an IME doctor. For one, they must be licensed health professionals. Some states also require that the medical institutions they work for must be HIPAA compliant.

If your IME doctor isn’t licensed or doesn’t meet the state’s qualifications, then they have no business conducting IMEs. In short, their opinion is invalid. You can use this to contest the IME report at court.

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.