When you suffer a workplace injury in North Carolina, navigating the workers’ compensation system can be overwhelming. One aspect of the claims process that often causes confusion and concern is the independent medical examination, commonly known as an IME. Employers and their insurance companies frequently use these examinations to obtain second opinions on your condition, question your authorized treating physician’s recommendations, or challenge your claim altogether. It is essential to understand that the authorized treating physician is the doctor primarily responsible for your care, while the IME doctor is selected by the insurance company or employer to provide an independent evaluation, which may not always align with your treating physician’s opinions.
If your employer has scheduled a workers’ comp IME, you need to understand your rights and how these examinations can impact your benefits. The IME doctor is not always acting in the injured employee’s best interests, so it is crucial to be prepared and informed. Hardison & Cochran has over 40 years of experience protecting injured workers’ rights during the workers’ comp independent medical exam process.
What Is an Independent Medical Examination in Workers’ Compensation?
An independent medical examination for workers’ compensation is a medical evaluation performed by a physician chosen and paid for by your employer or their insurance carrier. Despite its name, workers’ comp IME is conducted by a doctor selected by a party with a financial interest in limiting your benefits.
Employers request workers’ comp independent medical exams to obtain second opinions on recommended treatment, adjust work restrictions, challenge your authorized treating physician, or support a denial or termination of benefits. The IME doctor is not your treating physician or authorized treating physician. Your treating physician is the primary healthcare provider managing your ongoing care, while the IME doctor is an independent examiner who does not provide treatment but evaluates your condition for the employer or insurance carrier. An IME often signals that a medical issue in your case will be contested. North Carolina General Statute 97 27 gives employers broad authority to require these exams, and you must attend at reasonable times and places whenever requested or ordered by the Industrial Commission.
Employers can also demand a workers’ comp IME even if your claim has been denied, which creates additional leverage in disputed cases. IMEs differ from regular treatment because the IME doctor is not providing care but performing a single evaluation to assess your condition. They also differ from your right to a second opinion, which applies when you disagree with a disability rating and seek another physician’s assessment. The IME doctor’s report can play a significant role in your workers’ compensation claim, as it may influence benefit decisions and the outcome of your case.
North Carolina Industrial Commission Overview
The North Carolina Industrial Commission (NCIC) is the backbone of the state’s workers’ compensation system, ensuring that injured workers receive the support and benefits they need after a workplace accident or occupational disease. As the primary authority administering the North Carolina Workers’ Compensation Act, the NCIC oversees every step of the workers’ compensation claim process, from initial filing to final resolution.
In North Carolina, most employers are required by law to carry workers’ compensation insurance. This insurance is designed to provide essential benefits to employees who suffer a work-related injury or illness, including medical treatment, wage replacement, and various forms of disability benefits such as temporary total disability, temporary partial disability, and permanent partial disability. The NCIC is responsible for making sure employers comply with these requirements and that injured workers have access to the compensation and care they deserve.
When an injured worker files a workers’ compensation claim, the NCIC reviews the details to determine eligibility for benefits. The Commission may order an independent medical examination (IME) to get an objective assessment of the worker’s medical condition and the extent of any disability. The findings from the IME doctor’s report help the NCIC decide what benefits—such as medical expenses, wage benefits, or permanent disability compensation—the worker should receive.
Disputes sometimes arise between injured workers, employers, and insurance companies over issues like the extent of an injury, the need for ongoing medical treatment, or the amount of disability benefits owed. The NCIC provides a formal process for resolving these disagreements. If you disagree with the initial determination of your claim, you have the right to request a hearing before the Industrial Commission. During this process, you can present evidence, call witnesses, and have a workers’ compensation lawyer represent your interests.
Ultimately, the North Carolina Industrial Commission is dedicated to protecting the rights of injured workers and ensuring fair access to workers’ compensation benefits. If you have questions about your claim, the claims process, or your rights after a workplace injury, consulting with an experienced workers’ compensation lawyer can help you navigate the system and request the benefits you are entitled to under North Carolina law.
Your Rights During an IME in North Carolina
North Carolina law gives injured workers specific protections during the independent medical examination process. Knowing your rights ensures the IME is conducted fairly and your condition is accurately represented.
- The right to have your own physician present allows you to bring your doctor to the IME. Your physician must be provided and paid by you, ensuring the examination reflects your true medical condition.
- Examining physician requirements mandate that the IME is performed by a licensed North Carolina physician at a reasonable time and location. Extreme travel distance may justify adjustments, but timing and location must fit your circumstances.
- Communication with the IME physician permits the employer or insurance company to provide case information, medical records, and perspectives on your injury, either orally or in writing, even if the examiner has not yet physically seen you.
- The right to receive the IME report ensures you obtain the examiner’s report within 10 business days of the employer receiving it, along with all documents and communications considered during the evaluation.
- No physician-patient privilege applies, meaning the IME physician can testify about their findings and any information received during the examination in workers’ compensation proceedings.
If you have concerns about the IME process or want to ensure your rights are fully protected, seeking legal help can provide valuable guidance and advocacy.
How to Prepare for Your Independent Medical Examination
Proper preparation for your independent medical examination for workers’ compensation can help protect your legal claim. The examination is an important event that can significantly impact your benefits.
Be ready to clearly explain when the injury happened and the circumstances of your work injury, as this information is crucial for proper documentation. It is also essential to seek prompt medical attention and follow up with appropriate medical care after your work injury to ensure your claim is supported by medical records. Additionally, be prepared to discuss any missed work or light-duty assignments with the IME doctor, as these topics are often reviewed during the examination.
Review Your Medical History
Before the examination, review your medical history related to your workplace injury. Know the dates of important events, treatments you have received, and how your condition has progressed. It is essential to note which body part was injured and how it has been affected, as this information is used to evaluate the extent of your injury and impacts the calculation of workers’ compensation benefits. Be prepared to clearly explain how the injury affects your daily life and ability to work.
Be Honest and Accurate
The most important thing you can do during an IME is to be completely honest and accurate. Do not exaggerate your symptoms or limitations. The examining physician may observe you before and after the formal examination, including watching how you move in the parking lot or waiting room. Inconsistencies between what you report and what the doctor observes can be used to question your credibility.
Practice Your Explanation
It may seem awkward, but practice explaining your injury and its impact a few times before the examination. You want to communicate clearly without forgetting important details. You do not need a memorized script, but you should be able to give a coherent account of your condition.
Avoid Negative Comments
Do not disparage your employer during the examination. Keep the focus on your medical condition and its effects on your ability to work. Leave your employer out of the discussion except as necessary to explain what happens when you were injured.
Bring Documentation
Bring any relevant medical records, a list of medications you are taking, and contact information for your treating physician. Having this information readily available shows you are organized and serious about your claim.
Consider Having Your Attorney Present
Your workers’ compensation attorney can help you prepare for the IME and may be able to attend with you. Having legal representation ensures your rights are protected throughout the process.
What Happens If You Disagree with the IME Results?
The IME physician’s opinion can have significant consequences for your workers’ compensation benefits. If you disagree with their findings, you have options. The NC Industrial Commission plays a key role in resolving disputes over IME results, including reviewing evidence and making determinations in contested cases.
When challenging the IME findings, it is important to consider disability ratings and whether you have reached maximum medical improvement, as these factors are critical in determining the type and amount of benefits you may receive.
If you seek further evaluation, a permanent impairment rating may be assessed, which can directly impact the benefits an injured employee is entitled to under North Carolina law.
Consequences of Refusing an IME
If you refuse to submit to or obstruct an independent medical examination, your compensation can be suspended until you comply. No compensation will be payable for the period of obstruction unless the Industrial Commission determines that circumstances justify your refusal. This is a serious consequence, so you should consult with your attorney before refusing an IME.
Challenging the IME Findings
You can challenge the IME findings through the workers’ compensation hearing process. Your treating physician’s opinion often carries significant weight because they have provided ongoing care and have a more complete picture of your condition. Your attorney can present evidence that contradicts the IME findings and argue why the Industrial Commission should rely on your treating physician’s assessment instead.
Requesting Your Own Evaluation
Under North Carolina law, if you are dissatisfied with the percentage of permanent disability determined by your authorized health care provider, you are entitled to another examination on the disability rating issue. This examination is conducted by a physician of your choosing who is licensed to practice in North Carolina. The physician must be paid by your employer in the same manner as physicians they designate, though you are responsible for travel expenses.
How Hardison & Cochran Can Protect Your Rights During the IME Process
At Hardison & Cochran | Injury & Workers Comp Lawyers, we have spent over 40 years protecting injured North Carolina workers. Founded by Benjamin T. Cochran, our firm focuses on injury and disability law and navigating the workers’ comp IME.
Our results include $6.75 million for a paralyzed delivery driver, $3.5 million for a worker injured by falling trees, and millions more for workplace injuries. Contact us for a free consultation.
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