New York, NY – An injured worker’s entitlement to wage loss benefits, compensation for permanent injury, medical treatment, prescription medication and more depends on their medical provider. In addition to providing medical care, a worker’s treating doctor must be familiar with the workers’ comp system and its reporting requirements in order for the injured worker to receive the benefits they need.
The employer or insurance company does not have to accept the treating doctor’s opinion, and most of the time it will send the injured worker to see its own doctor for another opinion on the workers’ level of disability, need for treatment, permanent disability, or other issues.
Although the workers’ comp system calls these doctors “independent medical examiners” or “IMEs,” there is nothing independent about them. To the contrary, they are consultants hired by the insurance company, usually through a “vendor” that provides this service by using doctors who are familiar with the system and – more importantly – what the insurance company wants.
Of course, what the insurance company wants is to “limit its liability,” which translates to paying the injured worker and his or her doctors as little as it can. As a result, IME reports often find the worker to be less disabled and need less treatment than the treating doctor’s reports.
Injured workers do have some tools available to keep an eye on the IME. The most important tool is the worker’s right to bring someone to the IME appointment and to videotape the examination. The video can document what the IME did and did not do, whether the office was a suitable medical office, and how long the examination lasted. If the IME’s report claims that the exam took longer than it did, or misrepresents the tests that were performed, a judge may disregard the report and find in favor of the worker.