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  • IME Exam

    What is a IME evaluation? I injured my shoulder almost 6 months ago and I been on workers compensation ever since. I know it has something to do with their doctor but what kind of test will they perform? It is like 2 hrs away do I get travel time?
    What happens if their doctor tells me to go back to work or light duty and my doctor is telling me to keep doing physical therapy and not to work?
    What are the chances they will stop my benefits?
    Someone told me if I been out for more than 6 months they cant stop my payments is that true?
    Thank You

  • #2
    What state are you in? WC Laws vary by state. Your state will determine what compensation you are entitled to. Mileage and TTD for the day are pretty much standard though.

    An IME is an Independent Medical Exam. Essentially, it is a second opinion performed by a non-treating physician. I can't tell you what tests they might perform as I am not a doctor, nor the one performing the exam. Crystal ball is still on the fritz

    If the doctor releases you to light duty, and your employer can accommodate light duty, then your benefits can be cut off. If your doctor disagrees with this, then you can challenge the decision. How you do that varies by state. In no state can the carrier stop your benefits just because it has been 6 months. In nearly every state and with every carrier, the 6 month mark is about the time to look into an IME. You won't find that writen anywhere, but it is a common practice.

    I don't know what your diagnosis is, but it is extremely unusual to be out for six months with not even a light duty release for a shoulder injury. Now if your employer does not offer light duty, then you would still be entitled to TTD if you can not perform yor regular job.
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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    • #3
      Thanks for the quick response. I live in Rhode island and I have a rotator cuff injury. I seen a surgeon and he said that he recommends surgery but I want to do the physical therapy first, then if nothing helps I would consider the surgery. My job is heavy labor but my employer is saying that they could find a light duty job for me which would be like 2 hrs away from my house. Do they usually send you back to work if you are being recommended for surgery. Two more weeks then I hit 6 months so they cant stop my payments? Thats why they sceduled a IME so close
      Thank You

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      • #4
        They can't just stop the payments because you have reached the 6 month mark. Thry can if you are offered light duty and turn it down. If the offer of light duty is unreasonable, then you *may* still be able to receive TTD even if you turn it down. A 2 hour commute may not be reasonable, though in some cases it very well might be. There are no set in stone guidelines for what is and is not reasonable. In some places a 2 hour commute is the norm.

        Yes, you can be required to perform light duty even if surgery is indicated. That isn't unusual at all.
        I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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        • #5
          Thank You once again.

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          • #6
            Originally posted by KOPJ10 View Post
            they could find a light duty job for me which would be like 2 hrs away from my house.
            That is part of the "game." They will offer you light duty, but at the extreme limit of whatever is allowable under state law for the distance (I have no idea of what the distance is in your state, but it the time is about right for what it would be in mine).

            If you refuse light duty which is within the limits allowed by law, you lose. Period. End of question.

            This is an attempt to force you to quit, rather than drive two hours for a made up job. Trust me, the job is fabricated, just for you.

            You can take it and be paid, which will keep the employer from paying extra workers comp premiums in the future or you can turn it down, which will save the company a lot more and you will get squat.
            Senior Professional in Human Resources and Certified Staffing Professional with over 30 years experience. Any advice provided is based upon experience and education, but does not constitute legal advice.

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            • #7
              Actually, your doctor doesn't call the shots. No one doctor in WC does. When there are conflicting opinions it usually goes before the Commission in some form or other and they make the determination as to which side is the most reasonable. It can go either way. With an injury to just one arm, I wouldn't bank on "reasonable" being sitting home with no light duty. The whole purpose of WC is to get employees back to work, not pay them to be off. An attorney isn't necessarily the magic key to getting out of light duty. Trust me. Every single one of my light duty folks save one is represented.

              Light duty isn't necessarily an evil devised to jip employees out of benefits. There are significant advantages for the injured worker as well. Those who come back on light duty tend to heal faster and more fully, have fewer complications, suffer from less depression, and have fewer secondary complications.
              I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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              • #8
                In a word, yes. Do the opinions always contradict? no. Does the employer/insurer always take the word of the IME over that of the treating physician? no. Can it happen and is it legal? of course.

                Most states have created regulations surrounding the IME, including dictating the specialty of the doctor, what records were reviewed, the time spent with the patient and a detailed accounting of how they arrived at the results they did.
                I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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                • #9
                  What one dishonest doctor did a year ago has no bearing on the way the vast majority of cases go.
                  I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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                  • #10
                    We can debate all day the merits of an IME, and for every good doctor out there I'm sure there is a bad one. It doesn't change anything as far as WC goes. While there may be some that are more conservative, there are some that are extremely liberal and would find an employee disabled from a papercut. And no, that is not an exaggeration.

                    If every doctor agreed the WC commissions would be very bored indeed. There is a reason that there are regulations set up to handled such cases. Yes, it is a pain in the neck, but it is the system we've got. And most of the time, while imperfect, it works. Cases like yours are still the minority.
                    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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                    • #11
                      Originally posted by e3mrk
                      You are right,There are two types of Doctor,
                      First you have the dishonest ones that just want to make a buck as fast as they can and then you have the ones that dont work for the W/C.
                      And all your paranoia is helping the OP how? I notice the OP hasn't been back in a week. Obviously, he/she felt the advice and counsel given by the expert here in WC was sufficient.
                      I don't respond to Private Messages unless the moderator specifically refers you to me for that purpose. Thank you.

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                      • #12
                        Thanks for the laugh. Believe me, my problems with the WC system are not few. I am far from a cheerleader. However, a cynical attitude isn't going to change things nor answer the OP's question. Whether I like how the IME's work or not, and whether I agree with the physician's findings or not, it is what it is.

                        The OP didn't ask for our opinions on how efficient the system is or for the worst case scenario. Nor would this forum be the appropriate place to do that.
                        I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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                        • #13
                          Hi everyone I just came back from my IME and It took me almost 2hrs to get there and the doctor looked at me for about 5 minutes. She told me all I can do right now is do what my treating doctor is telling me to do. She did simple things like see how far my arm goes back and touching it to see where the pain is coming from. She asked me like three times if I ever had a shoulder problem before. Then she tells me good luck and I was all done with that. So now what should I expect from the workers comp? Will they contact me telling me the results? Do they usually stop your benefits? Any info would be great!

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                          • #14
                            No one here can predict what the carrier will decide. If it sounds like this doctor agreed wit hthe advice of your treating physician, then that is most likely what the carrier will do. It generally takes about a week or so to get the formal report from the exam. You may request a copy of the report.
                            I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

                            Comment


                            • #15
                              Thank You ELLE

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