3 THINGS NOT TO SAY TO YOUR WORKERS' COMP DOCTOR
Suppose you've suffered a work-related injury and have already filed for workers' compensation benefits.
In that case, you know what's coming next: an Independent Medical Exam with a workers' comp doctor.
Researchers discovered that there are over 4.5 million workplace injuries every year, and workers' compensation claims payouts totaled some $62 billion in 2017 — a staggering amount of money.
So when insurance companies go around "requesting" these Independent Medical Exams (IME) to verify the extent of the victim's injuries, the reality is — these exams are required.
You see, a visit with an insurance company-appointed doctor is an essential part of the claims process in any worker's compensation case.
If an employer has an injured employee on their hands, then the insurance company will want to do everything they can to prove the extent of the injury and make every effort to minimize their liability.
That's why an insurance company-approved treating doctor will need to visit with the injured employee to evaluate the extent of the injuries sustained from a workplace accident.
That way, the workers' compensation insurance company will have a better understanding of the cause, the extent, and restrictions of your injuries and be able to make a final decision on your compensation claim.
If you have been called to complete an IME — or you're expecting the request from the insurance carrier — then here's what you need to know about the process.
In this article, you'll learn what not to say to a workers' comp doctor.
But before we dive in, a quick definition.
What is an Independent Medical Examination (IME)?
An IME is a formal medical exam used to evaluate the extent of your (usually) workplace injury.
Once the insurance company is notified of your claim request, they will request that you submit to an Independent Medical Examination (IME).
Independent medical exams are typically requested when:
The insurance company disagrees with your own doctor's opinion
Negotiations with the claims adjuster are taking too long, or becoming too expensive
Your treating physician determines total or partial disability
While insurance companies position this as a "request," make no mistake: failure to submit to the IME will result in the denial of your workers' compensation claim.
This doctor administering the IME will be an expert on workers' compensation cases and injuries. You can expect this doctor to be chosen for you by the insurance company.
If your employer's insurance company is required to compensate you for your workplace injury, then you can be sure they'll do everything they can to limit the benefits payouts.
The surest way to limit your workers' comp is to have "proof" from your workers' compensation doctor that you're ready and fit to go back to work.
The doctor's evaluation will decide on any physical work restrictions, recommendations for time off work, or perhaps returning to work on light duty (work that can be completed without interfering with your injury).
Workers' comp doctors work for the insurance company
Remember, the doctor's objective for your IME is to check on your work status and determine when you can go back to work. The workers' comp doctor is, after all, an extension of the insurance company, which is why they must manage each workers' comp case carefully to limit their liability.
The independent medical exam can have a significant impact on the outcome of your claim. Your doctor can use your exam results to determine the right course of treatment and medical care.
After all, the sooner the injured employee can return to work, the better.
What to expect during an IME
During the independent medical exam, the doctor's objective is to evaluate the extent of your work injury and pass off this information to the insurance company (their employer).
The workers' comp doctor will be looking at your physical appearance and how you move:
How easily can you sit and stand?
Do you limp or groan in discomfort when you move?
Did you struggle to get in and out of your car in the parking lot?
The doctor will be looking very closely at physical signs of pain or discomfort — or lack thereof.
During the IME your doctor will first ask you about your medical history, any pre-existing conditions, and any medical treatments you may have used in the past.
Be prepared to explain in detail how your work accident has affected your daily life and don't try to downplay any details.
Remember, the doctor has you under close surveillance. They are looking for anything that suggests your condition is not as bad as you say.
For that reason, make sure to share accurate details that indicate how your quality of life has suffered from the accident.
If you decide you want to switch to another doctor (get a second opinion), you can usually do so with a simple request. However, the insurance company will prefer the new doctor to be within its coverage network.
The most important thing you can do during your IME is to be honest. Insurance companies are skilled at finding inconsistencies in your statements and symptoms and will use those inconsistencies to destroy your workers' comp claim.
Avoid raising any red flags in your claim process by following three simple rules.
3 Things Not to Tell the Doctor During Your IME
Remember, the outcome of your IME has the potential to make or break your workers' comp claim.
Follow these three tips to ensure you communicate the right information to the doctor for the best possible outcome in your case.
1. Don't Exaggerate Your Symptoms
Yes, you want to make sure your symptoms don't go unnoticed by your doctor. But at the same measure, workers' comp doctors are usually well-trained to spot exaggerated claims and false displays of suffering.
During an IME the doctor will run you through a series of tests and exams to diagnose the cause of your pain, suffering, and discomfort. Some of these tests are intended to gauge your response to pain or even lack of response.
You may think that exaggerating your symptoms will only increase the chances of a sizable workers' comp payout. Let me assure you: Nothing could be further from the truth.
You must be honest about your symptoms.
If you choose to exaggerate your symptoms and the doctor believes you aren't telling the truth, that may be reason enough to deny your claim.
Not only do workers' comp doctors have a high degree of intuition about whether patients are being truthful or not, they also have medical instruments and diagnostic technology to reveal those exaggerations.
As an employee, you do not want to lose credibility and risk the insurance benefits that are rightly yours — be honest about your symptoms.
2. Don't Speak Negatively About Your Employer
Do not be rude or difficult, and don't speak negatively about your employer.
As an injured employee, it's quite possible you harbor some negative feelings about your employer. This is natural. Especially if you were injured in the workplace due to negligence or unsafe working conditions, you might feel some strong resentment or bitterness. It is ok to feel this way, but try not to indulge these feelings and disparage your employer during your exam.
You want to leave your doctor with a positive, glowing impression of you; you want the doctor to be on your side.
And if you speak badly about your employer, this may tarnish the doctor's impression of you. What's more, those bad things you say about your employer may find their way into your official medical report, casting more doubt on your case as a whole.
As a rule of thumb, act as if everything you tell the workers' comp doctor will find its way to the insurance company and your employer.
3. Don't Lie
I've noticed several articles on the internet attempting to advise on what not to say to a workers' comp doctor during an IME. Many of these articles do a decent job, but in my experience, the golden rule that leads to success is simple: don't lie.
You've been injured at work. You want to receive the benefits you deserve to cover the cost of your treatment plan and physical therapy if needed. And while the temptation to exaggerate or embellish your condition may be strong, trust me when I say that you must stick to the facts and be honest about your story.
Here are two more tips that will help:
Don't leave out prior injuries — You may think insurance companies will be more likely to deny your claim if you already have existing complications in your medical record. Let me assure you that this is false. But you must be prepared to describe the circumstances of the previous or existing injury.
You should also be able to explain how the pain from your new injury is different or more severe than your old injury. That is key: if you can do that, there is no reason to hide an old injury.
Don't omit details about the accident — Your recount of how the accident happened must be consistent from your initial accident report to what you report to the doctor and insurance adjuster.
You might be tempted to leave out embarrassing details or make you look bad — don't. Your doctor is trained to spot inconsistencies in your story. If they discover that you haven't told the full story, or have withheld vital details, this discrepancy may jeopardize your claim's chance of success.
If you are in the process of pursuing workers' compensation, you would be well-advised to be honest every step of the way, disclosing every detail that helps tell the true story of your unfortunate accident.
How to Protect Your Workers' Compensation Claim
As a workers' compensation attorney, I have seen it all. And if there is one piece of advice I can give you about what not to say to a workers' comp doctor it is this: stick to the facts!
Be honest and speak to the facts.
When you are requested to complete your IME, don't say anything untruthful or anything that might risk your claim's denial.
To recap, here are three things not to tell your workers' comp doctor:
Don't exaggerate your symptoms
Don't be rude or negative
Don't lie
If you follow these three tips, you will be in the best position to get your claim approved and receive fair compensation for your injury.
Let an Experienced Workers' Comp Attorney Help Maximize Your Injury Claim
The process of filing a workers' comp claim and fighting for the benefits you rightly deserve can be difficult and time-consuming. Thankfully, there is no need to try and handle this alone. Let someone who is experienced in workers' compensation law and the court systems help you take the next steps to make your case a success.
John Bruscato is an expert workers' compensation lawyer and has worked with countless injured workers to receive the compensation they deserve. At Bruscato Law Firm, we will do everything in our power to advance your workers' comp claim and win maximum compensation for your case.
If you live in the Monroe, Louisiana area and need personal injury legal advice, call us today at 318-855-1616 or visit our appointment page to schedule your free consultation.