Thousands of people sustain work-related injuries each year, and any work injury has the potential to cause severe medical complications for the victim. Almost every employer must have workers’ compensation insurance under state law, and this insurance can be a valuable lifeline for any injured worker and their family when they are left unable to work from their injury. If you or a loved one recently suffered any injury at work, it is crucial to know your rights and your legal options for recovering from the incident as fully as possible.
One of the most important aspects of a workers’ compensation claim is the benefits determination, which explains how much of the claimant’s medical expenses the insurance carrier will cover and how much the claimant can receive in ongoing disability benefits. As part of the claim review process, the claimant may need to undergo an independent medical evaluation (IME).
The rules for IMEs are different among all the various workers’ compensation insurance carriers operating. Every injured worker will have a unique experience with their claim filing process, and there is always a chance for an insurance carrier to dispute a claim. Having experienced legal counsel on your side makes every aspect of your claim easier to manage.
What Does an IME Involve?
The purpose of an IME is ostensibly to ensure that the workers’ compensation insurance carrier accurately assesses a claimant’s medical condition and covers all necessary treatments. In reality, an IME is essentially another opportunity for a workers’ compensation insurance carrier to dispute a claim. Some claimants will need to undergo IMEs from workers’ compensation physicians at the outsets of their claim filing processes. Others are permitted to see their own doctors for treatment and bill their employers’ workers’ compensation insurance policies, and an IME may come into play if the insurance carrier disputes the charges, claiming that the worker is undergoing unnecessary and/or excessive treatment.
During an IME, the physician reviews the injured worker’s condition and assigns them a disability rating. This rating takes the overall severity of the injury into account and assigns a numerical value to the level of long-term or permanent harm they are likely to experience from the injury. The higher the rating, the more the worker receives in benefits.
If you are required to undergo an IME as part of your claim filing process, your workers’ compensation attorney can ensure that the doctor assesses your condition fairly. If any disputes arise, you have the right to seek a second opinion. Having legal counsel on your side will make dealing with workers’ compensation doctors and workers’ compensation insurance company representatives much easier. Once you recover as much as you can in workers’ compensation benefits, your attorney may identify additional avenues of legal recourse that could enable you to recover even more fully from your injury.
FAQs
Q: When Do I Need to Undergo an IME for Workers’ Compensation?
A: An IME may be a necessary component of your workers’ compensation claim filing process. If your employer’s insurance carrier requires an IME, you will need to complete this before it will deliver a benefits determination. Alternatively, if you are permitted to see a doctor of your choice, the insurance company may order an IME if it believes you are undergoing excessive or unnecessary medical treatments.
Q: What Is the Difference Between an IME and a QME?
A: An IME intends to review the medical status of an individual for the purposes of a disability rating. A qualified medical evaluation (QME) will come into play when a claim is disputed. The California Division of Workers’ Compensation (DWC) will arrange for a QME to evaluate a claimant’s condition for the purposes of resolving a disputed workers’ compensation claim with their employer’s insurance carrier. It’s important to note that while an IME is a standard component of the workers’ compensation claim filing process for most injured workers, QMEs will only come into play at the behest of the DWC when a claim is disputed.
Q: What Does Maximum Medical Improvement Mean in a Workers’ Compensation Case?
A: The term “maximum medical improvement” refers to the greatest level of recovery that a person can possibly reach after experiencing an injury. The purpose of the medical expense coverage a claimant receives is to help them recover as fully as possible from their injury, and this may entail a combination of immediate care and ongoing treatments intended to help them recover as much functionality as possible.
Q: How Much Medical Expense Coverage Can I Receive Through Workers’ Compensation?
A: Workers’ compensation laws require an insurance carrier to cover all medical care that a claimant requires to reach maximum medical improvement from their injury. This includes both immediate medical care the claimant requires and any expenses for rehabilitative care. This is why IMEs often come into play in these cases; insurance carriers want to be sure they are only paying for what is strictly necessary. If you do not agree with the results of an IME, an attorney can assist you in securing a second opinion under certain conditions.
Q: Do I Need a Lawyer to File a Workers’ Compensation Claim?
A: It is technically possible for an individual to file their own workers’ compensation claim without hiring legal counsel. However, the average person could easily make mistakes that lead to delays and other complications with their claim. Hiring an attorney to help you not only minimizes the chances of encountering any bad faith tactics from an insurance carrier but also increases your chances of maximizing the total benefits you secure from the claim.
Ultimately, any workers’ compensation claim has the potential to generate complex legal disputes between the claimant, their employer, and/or their insurance carrier. When you have an experienced attorney handling your case, you are more likely to reach a positive outcome in your claim filing process, and you will be prepared to address any issues that arise with your claim with confidence. Contact Pratt Law Corporation today to schedule your consultation with our team and learn more about the legal services we offer.
