What Is an Independent Medical Examination?
Summary: If the insurance company is requesting that you have an independent medical examination, as unfair and inconveniencing as it might seem, you do have to submit to it, or you will likely be denied eligibility.
If you are a worker in the state of Missouri and you are hurt while you are at work, then quite likely you are covered by workers’ compensation. In St. Louis, any business owner who has more than five employees or owns a construction company with any number of employees is required to have workers’ compensation insurance.
What Is Workers’ Compensation Insurance?
Workers’ compensation insurance coverage is a policy to protect workers while they are on the job. If you hurt yourself while you are engaged in activity that is under the scope of your workplace duties, then you are generally covered by workers’ compensation insurance.
When you are injured, you must make your employer aware, and you have thirty days to file a claim.
Once you file a claim, a decision is made about your eligibility based on things like whether you were engaged in work-related activities or something non-work-related. If your employer covers you, and the injuries are real, you will need documentation from a physician not just that your injuries were sustained at work, but also the extent of them.
What is an IME?
If the insurance company questions your claim, they might require that you submit to an IME. An IME is an independent medical examination, which is given by another physician. The insurance company is allowed to make you submit to an IME; and, although they get to choose which physician you go to, they also have to pay for the medical evaluation.
If the insurance company is requesting that you have an independent medical examination, as unfair and inconveniencing as it might seem, you do have to submit to it, or you will likely be denied eligibility. The insurance company has a right to refuse you coverage for refusal to submit.
What If the Ime and My Physician Disagree?
If the independent evaluation concludes that your injuries are not what you claim, then you will have a chance to have your case heard and ruled on.
The three ways that an IME can help the insurance company limit your coverage, or deny it altogether, is if the independent examiner says that you weren’t hurt the way that you claim, your injuries aren’t as severe as you claim, or that you aren’t injured at all.
If you are asked to submit to an IME, then you have to get it done, or you will risk losing your workers’ compensation benefits. Be aware that an IME is ordered to try to prove that your injuries aren’t what you say they are. It is critical that you have a St. Louis workers’ compensation attorney to help you through the IME process and to ensure that your benefits continue.
Law Office of James M. Hoffmann
2001 S Hanley Rd #325
St. Louis, MO
Phone: (314) 361-4300
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