Minnesota Workers’ Compensation IME: What to Expect and How to Prepare

Minnesota Workers’ Compensation IME: What to Expect and How to Prepare

If you have a Minnesota workers’ compensation claim, the insurance company may eventually schedule you for an independent medical examination, commonly called an IME.

Despite the name, the doctor performing the examination is selected and paid by the employer or workers’ compensation insurer. The IME doctor is not your treating physician and does not provide your medical care.

Instead, the doctor evaluates you and gives the insurance company medical opinions about your workers’ compensation claim.

Those opinions can become extremely important.

An IME report may address whether your injury is work-related, whether you need additional treatment, whether you can return to work, whether you have reached maximum medical improvement, whether you have permanent disability, and whether restrictions recommended by your treating doctor are still necessary.

Understanding what the examination is—and what it is not—can help you approach it calmly and appropriately.

What Is an IME in Minnesota Workers’ Compensation?

Minnesota Statutes § 176.155 allows an employer or workers’ compensation insurer to have an injured employee examined by a physician of its choosing.

The examination is commonly referred to as an independent medical examination or adverse medical examination.

The doctor may be asked to review your medical records, examine you, and answer questions raised by the employer and insurer.

Common questions include:

• Did the employee sustain a work injury?
• What is the employee’s diagnosis?
• Is the employee’s current condition related to the work injury?
• Was the work injury temporary or permanent?
• Has the work injury resolved?
• Is additional medical treatment reasonable and necessary?
• Is proposed surgery appropriate?
• Does the employee need work restrictions?
• Can the employee return to the pre-injury job?
• Has the employee reached maximum medical improvement?
• Does the employee have permanent partial disability?
• Did a pre-existing condition cause or contribute to the employee’s symptoms?

The precise questions depend on the dispute.

Is the IME Doctor My Doctor?

No.

The IME doctor is examining you for the purpose of giving an opinion to the employer and insurance company.

The doctor is not taking over your medical care.

You should generally continue treating with your own health care providers unless there is some separate reason for your treatment to change.

Do I Have to Attend the IME?

Generally, yes.

Minnesota law gives the employer and insurer the right to request a reasonable medical examination.

If you simply refuse to attend, there can be serious consequences.

An employee who refuses to comply with a reasonable request for examination may risk suspension of workers’ compensation benefits while the refusal continues.

That does not mean every examination request is automatically reasonable.

If you believe there is a legitimate problem with the examination—for example, the location, timing, physician, physical ability to travel, or repeated examinations—speak with your workers’ compensation attorney rather than simply failing to appear.

How Far Can the Insurance Company Make Me Travel for an IME?

Minnesota law generally limits how far an employee can be required to travel for an employer’s examination.

If the proposed examination location creates a significant travel problem, ask your attorney to review whether the request is reasonable under Minnesota law.

Travel distance, medical condition, transportation needs, and the availability of appropriate physicians may all matter.

Does the Insurance Company Have to Pay My Travel Expenses?

Reasonable expenses associated with attending an employer-requested examination may be compensable.

These can include things such as:

• mileage;
• parking;
• lodging when necessary; and
• meals when necessary.

Lost wages caused by attendance may also be an issue.

Keep records of your mileage, parking expenses, receipts, and any work time you lose because of the IME.

Can I Bring Someone With Me to the IME?

Minnesota law may allow an injured employee, upon request and in appropriate circumstances, to have another person present during the examination.

If you want someone present, address that before the examination rather than simply arriving with another person and assuming there will be no objection.

If you are represented by an attorney, discuss the issue with your attorney beforehand.

What Medical Records Does the IME Doctor Receive?

The employer and insurer will typically provide the IME physician with medical records relating to your claim.

Those records may be extensive.

Depending on the case, the doctor may receive:

• emergency room records;
• primary care records;
• orthopedic records;
• physical therapy records;
• chiropractic records;
• diagnostic imaging reports;
• surgical records;
• prior medical records;
• work restrictions;
• records involving prior injuries;
• rehabilitation records;
• deposition testimony; and
• other materials relating to the claim.

The insurer may also send the physician a letter explaining the history of the case and asking specific medical questions.

This is why consistency in your medical history matters.

The IME physician may compare what you say during the examination with what appears in your prior records.

What Happens During an IME?

Each examination is different, but an IME commonly has several parts.

Medical history

The physician may ask you about:

• how the work injury occurred;
• your symptoms;
• prior treatment;
• medications;
• prior injuries;
• prior medical conditions;
• surgeries;
• current physical limitations;
• work status;
• hobbies and activities; and
• what makes your symptoms better or worse.

Physical examination

Depending on the injury, the physician may evaluate:

• range of motion;
• strength;
• sensation;
• reflexes;
• tenderness;
• gait;
• grip strength;
• joint stability; and
• other physical findings.

Records review

The physician may review medical records and diagnostic studies before or after examining you.

The actual face-to-face examination may sometimes be relatively brief even though the resulting report is lengthy.

How Should I Prepare for an IME?

You do not need to study for an IME or memorize your medical records.

The most important preparation is to be accurate, straightforward, and consistent.

Before the examination, it is helpful to refresh your memory concerning:

• when the injury occurred;
• how it occurred;
• your primary symptoms;
• treatment you have received;
• surgeries or injections;
• current medications;
• current work restrictions;
• whether you are working;
• what activities you can and cannot perform; and
• any significant prior injuries involving the same body part.

If you do not remember an exact date, say that you do not remember.

Do not guess.

Should I Tell the IME Doctor Everything That Hurts?

Answer the physician’s questions honestly.

Describe the symptoms that you actually experience and their effect on your activities.

You do not need to exaggerate your limitations to prove that you are injured.

Likewise, do not minimize symptoms because you want to appear cooperative or tough.

Accuracy is more important than trying to present yourself in any particular way.

For example, there is a meaningful difference between saying:

“I can never lift anything.”

and saying:

“I can lift light objects, but heavier lifting significantly increases my shoulder pain.”

The second description gives the physician—and later a compensation judge—a more useful understanding of your actual functional ability.

What Should I Avoid Doing at an IME?

Several simple rules help.

Do not exaggerate

Exaggeration can damage credibility.

If you can perform a movement, do not pretend that you cannot.

If something hurts, accurately describe where and when it hurts.

Do not minimize your symptoms

Some injured workers instinctively say they are “fine” even when they are not.

The IME is not the time to minimize genuine problems.

Do not guess

If you do not remember when something occurred, say so.

An incorrect answer given as a guess can later appear inconsistent with your medical records.

Do not argue with the doctor

You may disagree with the physician or feel that the doctor is skeptical.

You do not need to persuade the physician during the examination.

Answer the questions politely and accurately.

Your attorney can address an unfavorable medical opinion later.

Avoid inaccurate absolutes

Statements such as “I never do that,” “I always have pain,” or “I cannot do anything” can create problems if the medical record or other evidence shows exceptions.

Describe your actual limitations.

Should I Discuss My Prior Injuries?

Yes, if asked.

Prior injuries and medical conditions are commonly relevant in workers’ compensation cases.

Trying to conceal a prior injury is generally far more damaging than acknowledging it.

A prior condition does not automatically defeat a workers’ compensation claim.

A work injury may aggravate, accelerate, or substantially contribute to a pre-existing condition.

The medical issue is often not whether a prior condition existed, but whether the work injury materially contributed to the current disability or need for treatment.

What If I Do Not Remember All of My Prior Medical Treatment?

Say so.

Many workers have decades of medical history and cannot remember the exact date or provider for every prior injury.

There is nothing wrong with saying:

“I remember having some back treatment years ago, but I do not remember exactly when.”

That is much better than guessing.

The physician can review the records independently.

Can the IME Doctor Change My Work Restrictions?

An IME physician may give an opinion that you need different restrictions—or no restrictions at all.

But the IME physician is not your treating doctor.

Your treating health care provider remains important in determining your medical restrictions and ability to work.

However, an IME opinion that you can work without restrictions may give the insurer a basis to challenge continued wage-loss benefits.

That dispute may then need to be resolved through the workers’ compensation system.

Can an IME Cause My Workers’ Compensation Benefits to Stop?

It can lead to an attempt to stop benefits.

For example, the IME physician may conclude that:

• your work injury has resolved;
• you no longer need restrictions;
• your current condition is unrelated to work;
• you can return to your regular job; or
• you have reached maximum medical improvement.

The insurer may then rely on that report to seek discontinuance of wage-loss benefits.

Receiving an unfavorable IME report does not itself automatically terminate benefits.

The insurer still must have a legally sufficient basis and follow the applicable discontinuance procedure.

Can an IME Doctor Say I Have Reached Maximum Medical Improvement?

Yes.

An IME physician may offer an opinion that you have reached maximum medical improvement, commonly called MMI.

MMI is the point after which no further significant recovery or lasting improvement can reasonably be anticipated.

An MMI determination can have important consequences for temporary total disability benefits.

MMI does not necessarily mean:

• you are fully recovered;
• you have no permanent restrictions;
• you need no further medical care;
• you have no permanent disability; or
• your entire workers’ compensation claim is over.

If an IME physician declares MMI and your treating doctor disagrees, that disagreement can become an important issue in the claim.

Can the IME Doctor Deny My Surgery?

The IME doctor does not personally “deny” surgery.

But the physician may issue an opinion that the proposed surgery is not reasonable, necessary, causally related to the work injury, or consistent with Minnesota treatment parameters.

The insurer may then rely on that medical opinion to refuse authorization.

If your treating surgeon believes surgery is necessary, the competing opinions may need to be resolved through a Medical Request, administrative conference, Claim Petition, or formal workers’ compensation litigation, depending on the nature of the dispute.

What If My Treating Doctor Disagrees With the IME?

That happens frequently.

Your treating physician may believe:

• you still need restrictions;
• you have not reached MMI;
• your condition is work-related;
• additional treatment is necessary;
• surgery is appropriate; or
• you have permanent disability.

The IME physician may reach the opposite conclusions.

The fact that one doctor was selected by the insurance company and another treated you does not automatically determine which opinion will ultimately prevail.

A compensation judge may consider factors such as:

• each physician’s expertise;
• familiarity with the medical history;
• objective medical findings;
• diagnostic studies;
• accuracy of the factual assumptions;
• quality of the medical reasoning; and
• whether the opinion has adequate foundation.

In some cases, your attorney may ask your treating doctor to prepare a detailed report responding to the IME physician’s conclusions.

When Will I Receive the IME Report?

The physician may take some time after the examination to prepare the report.

Once the report is issued, Minnesota law contains requirements concerning service of the report on the employee and the employee’s attorney, if represented.

If you have an attorney, your attorney should receive a copy.

The report may be important because it can signal the insurer’s next move.

What Should I Do After the IME?

After the examination, make a few notes while the experience is fresh.

You may want to record:

• when you arrived;
• when the examination began and ended;
• who was present;
• what history the physician asked about;
• what physical tests were performed; and
• any unusual events during the examination.

Do not try to recreate every word of the conversation.

The purpose is simply to preserve your recollection if the eventual report describes something differently from what you remember.

When the written report arrives, review it with your attorney if you are represented.

The report may contain opinions that require a response from your treating physician or may signal the insurer’s next move.

What If the IME Report Contains Incorrect Information?

IME reports sometimes contain factual assumptions that the employee believes are wrong.

For example, the report might incorrectly state:

• how the injury occurred;
• what treatment you previously received;
• when symptoms began;
• what job you were performing;
• what your physician recommended;
• whether you had prior problems with the body part; or
• what you said during the examination.

Do not panic.

An inaccurate statement in an IME report does not become true merely because it appears in a physician’s report.

But significant inaccuracies should be identified.

A medical opinion based on an incorrect factual history may have less persuasive value.

Your attorney can determine whether the problem should be addressed through medical evidence, cross-examination, deposition testimony, or another part of the litigation.

Should I Hire a Minnesota Workers’ Compensation Attorney Before an IME?

Not every injured worker needs an attorney solely because an IME has been scheduled.

But an IME often signals that the insurer is evaluating a significant disputed issue.

You should consider speaking with a workers’ compensation attorney if:

• the insurer has denied your claim;
• you are receiving wage-loss benefits;
• surgery has been recommended;
• the insurer is questioning whether your injury is work-related;
• the insurer claims your condition is pre-existing;
• you have been off work for an extended period;
• your doctor has permanent restrictions;
• you may have permanent disability;
• the insurer is considering stopping benefits; or
• a Claim Petition is already in litigation.

An attorney can explain what issues the IME physician is likely being asked to address, review the resulting report, and respond if the insurer uses that report to deny benefits.

Minnesota Workers’ Compensation Attorneys Representing Injured Workers

Lemmon & Tanasychuk, LLC represents injured employees throughout Minnesota.

We represent workers—not employers and insurance companies—in Minnesota workers’ compensation claims involving:

• independent medical examinations;
• denied claims;
• stopped wage-loss benefits;
• denied surgery and medical treatment;
• maximum medical improvement;
• permanent work restrictions;
• permanent partial disability;
• rehabilitation and QRC disputes; and
• workers’ compensation settlements.

If you have been scheduled for an IME or have received an unfavorable IME report, we can review your claim and help you understand what the report may mean for your benefits.

Contact Lemmon & Tanasychuk, LLC for a free consultation.

This article provides general information concerning Minnesota workers’ compensation law and is not legal advice. The rights and procedures that apply depend on the facts of the individual claim, and workers’ compensation statutes and rules can change.