Sometimes during the course of treatment for a work injury, a claims representative will decide to request an independent opinion from another physician.
This can help in making determinations such as whether:
- The injury is work-related
- The employee could go back to work without or with fewer medical restrictions
- The employee is getting the right medical treatment
- The employee needs surgery
For example, an employee has already undergone two unsuccessful back surgeries and requests a third one, or an employee with arthritis claims that work aggravated the condition, causing the need for a total knee replacement.
In cases like these, a workers' compensation insurer might pay an independent doctor to review the employee's medical history, conduct a physical exam and give an opinion that can be used in a hearing. These are referred to as “independent medical examinations” in most states. There are states that don't have independent exams, however, such as Iowa where employers choose the treating doctor.
Here are a few things you should know about independent medical examinations:
- Timing is everything
If we arrange for the examination too soon, the doctor might conclude that more time is needed to determine whether the present course of treatment is working. This typically isn't a desired outcome, since usually one goal of requesting the independent examination is to gain support for a change in the course of treatment.
- They’re expensive
One examination can cost from $2,000-$12,000. For some injuries, examinations by multiple specialists might be necessary. For example, a head injury might require examinations from a neurologist, ophthalmologist, psychiatrist and other specialists.
- The conclusion isn’t always favorable
Of course, when requesting an independent medical examination, the claims representative is hoping it supports the employer’s case, but it’s not uncommon for the results to come back otherwise. Even though the insurance company is paying for the examination, it’s understood that the doctor is to give an honest opinion.
- They’re not final
Even if the doctor’s opinion seems favorable, it’s only one factor that will be considered by the judge in a litigated workers’ compensation claim. The judge will also consider the treating doctor’s opinion, any other medical opinions the employee has sought out, and the employee's own statements.
- Choice of doctor is critical
A judge can decide to throw out the results of an independent medical examination entirely if he or she believes an opposing opinion, such as that of the treating doctor, is more credible. Because of this, it’s important to choose a high-quality doctor who will provide a credible opinion backed up by the facts of the claim.
- They’re perceived as adversarial by employees
If an employee hasn’t yet retained an attorney, a request for an independent medical examination may compel the employee to do so. If the independent examination recommendations are counter to how the employee has been comfortable being treated, the likelihood of getting an attorney involved increases.
- They’re not the only option
There are other ways to learn more about an employee's medical condition, such as writing a letter to the treating doctor, or asking that the employee get a second opinion from a doctor of his or her choice. Another option in some states, including Minnesota, is to get a neutral evaluation in which the judge chooses a doctor to do the examination.
There is a lot to consider when requesting an independent medical examination, and SFM has doctors and attorneys on staff who provide advice when claims reach this point. Independent medical examinations typically aren’t necessary, but they can be useful tools.
This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.