If you have been receiving benefits for a work-related disability, you may be asked to submit to an independent medical exam, or IME.
Can you refuse an IME? Can you get a second opinion? What are your rights under New Jersey workers’ compensation regarding independent medical exams?
What is the purpose of a workers’ comp IME?
The stated purpose of an IME is to evaluate or re-evaluate your medical condition. Is your disabling injury/illness better, worse or the same?
But typically, when an employer or their workers’ compensation insurer requests an IME, they are angling to reduce your disability benefits or terminate your claim. They suspect that your injury is not as severe as initially stated, or that you have recovered or improved.
As a result of the exam, the employer might:
- Downgrade your disability rating, reducing your benefits by thousands of dollars over the duration of your claim.
- Recommend that your medical benefits be terminated or that a specific treatment be discontinued.
- Order you to return to work, even if you or your regular doctor think it is too soon.
Of course, it is also possible that your claim will be affirmed and your benefits will remain unchanged.
Can you say no to an IME? Can you appeal the findings?
Failure to submit to an independent medical exam is cause for denial of benefits. So no, you can’t refuse an IME. But you do you have some rights in the process.
The insurance company may recommend their own hand-picked doctor, but you are not obligated to consent. If you and the insurer cannot agree on a physician to perform the IME, you can request a state-appointed physician (who is presumably neutral). No matter who performs the exam, the insurance carrier pays all costs of the IME.
You are allowed to have your own doctor present during the exam, or a spouse or family member. You will typically not be informed of the findings from the IME. However, if you appeal a denied claim or termination of benefits, the defense will have to turn over the IME report during discovery.
Don’t hesitate to consult a workers’ compensation lawyer if you have been asked to submit to an IME or if you think your employer is trying to terminate your claim or cut your benefits.