Independent Medical Examinations (IME) in Massachusetts Workers Compensation Claims

medical-doctor-1314902-mInjured workers in Massachusetts who are eligible for Massachusetts’ workers’ compensation benefits may be required by the insurance company and/or their employer to submit to an examination by a registered physician.  This requirement is pursuant to Massachusetts General Laws, Chapter 152, Section 45.  The workers’ compensation insurer and/or the employer must pay for this examination.  This examination is typically scheduled by a workers’ compensation insurer at either the outset of the claim (just after the injury has occurred) or at a point in time where the insurer wants to either terminate or reduce weekly disability payments to the injured worker.  Many questions and issues typically arise for an injured worker when they receive a notice of an IME examination from the workers’ compensation insurer or their employer.  Here are some important things to know about the IME exam:

  1. Although these exams are commonly referred to as “independent” medical exams, there is nothing “independent”, neutral or impartial about them. The doctor is chosen by the insurance company and paid by the insurance company to presumably write a report that contains opinions which would allow the insurer or employer to deny the claim or support their defense of the claim if the claim is in litigation.
  2. The insurance company or the employer must send a written notice of the exam to the injured worker: the notice must set forth the date, time and location of the examination along with the name of the doctor conducting the examination.  Despite what the notice may state, the insurance company or the employer is responsible for providing medical records, x-rays and MRI’s to the examining doctor.
  3. The insurance company or employer is responsible for reimbursing the injured worker for travel expense incidental to the examination and shall also provide transportation to/from the exam if the injured worker cannot drive themselves.
  4. The injured worker MUST attend this examination and if they do not, the workers’ compensation insurer or employer may have the right to cease payment of weekly disability benefits.
  5. The injured worker does not have the right to choose the doctor performing the examination (however, the injured worker always has the right to choose their own treating doctors and should be very hesitant about accepting a referral to a treating doctor made by the workers’ compensation insurer, employer, or nurse case manager).
  6. The location of the examination must be within a reasonable distance of the injured workers’ place of residence.

The IME examination is a critical part of the workers’ compensation claim process.  There are many rules that an insurance company, employer and injured worker must follow in scheduling and conducting the examination.  The failure to follow these rules can have serious consequences to the outcome of the claim for all parties involved, including the injured worker.  Failure to follow these rules for an insurance company or employer can have consequences, but not as severe as the consequences for an injured worker who does not properly adhere to the rules of the IME.  An insurance company may simply have to reschedule and IME with a doctor closer to the residence of the injured worker, or resend proper notice. However an injured worker who does not understand the role of the IME in their claims process or follow rules associated with this IME exam may face consequences ranging from suspension of benefits to an adverse ruling by a judge denying their claim for benefits.

Massachusetts’ workers’ compensation attorneys can play a key role in guiding an injured worker through the IME process and overall claims process. Because Massachusetts’ workers compensation lawyers are prohibited from taking a retainer or charging hourly rates for their services, and work only on a contingent fee basis, it is advisable that an injured worker who receives an IME notice consult with an experienced attorney who can guide them through the process.