Workers’ compensation is designed to help injured New Yorkers get the medical care and wage replacement benefits they need after being hurt on the job. Unfortunately, the claims process isn’t always straightforward, especially when dealing with employers and their insurance companies.
At Nappa, Monterosso & Poznansky, LLP, our Staten Island workers’ compensation attorneys help clients navigate Independent Medical Exams (IMEs) in the greater New York City area. An IME can significantly influence the outcome of a case, so it’s important to understand their role in NY Workers’ Compensation Claims. Here, we explain how to prepare for your appointment and why the guidance of an experienced workplace injury lawyer is so important.
Key Takeaways
- Preparation—Talk to your attorney about what to expect and gather all relevant medical records and a detailed timeline of your injury, symptoms, and treatment.
- Professionalism—Arrive on time and treat the IME like a serious medical appointment, as the doctor will document your demeanor and conduct.
- Clarity and consistency—Stick to the facts about your pain, symptoms, and limitations. Do not exaggerate or minimize your injuries.
Understanding the IME in New York
What Is an Independent Medical Exam?
Sometimes called a consultative exam, an Independent Medical Exam is a medical evaluation requested by your employer or their workers’ compensation insurance carrier. The purpose of an IME is to assess your injury or occupational disease and ongoing need for benefits. Doctors who perform IMEs are selected and paid for by the insurer.
Why Would I Need an IME?
An insurer might request an IME for several reasons including:
- To question the connection between your injury and employment
- To dispute the necessity of a specific treatment
- To determine your current level of disability and ability to return to work
The findings of an IME can have a significant impact on whether a claim is approved, denied, or if current benefits will continue.
Deadlines and Forms Related to IME in NY
When an insurance carrier schedules an Independent Medical Exam, they are required to notify you using the official IME-5 Form (Claimant’s Notice of Independent Medical Examination). It details the date, time, and location of the examination.
The insurance carrier must provide this notice at least seven business days prior to the date of the exam. If they fail to give proper notice, your workers’ compensation attorney can challenge the validity of the scheduled IME.
Forms Submitted by the Doctor
Within 10 days of the examination date, an IME doctor must send an IME-4 Form (Report of Independent Medical Examination) and attached report to you, the New York Workers’ Compensation Board (WCB), the insurance carrier or self-insured employer, your attending physician, and your attorney.
The IME report includes a description of the examination, list of information reviewed by the doctor, and their professional opinion on your condition and the necessity of treatment. Any IME questionnaire or intake sheets completed by the claimant must also be included.
Understanding how these forms and deadlines work is essential to protecting your rights. If the insurance carrier or IME doctor fails to follow proper procedures, your Staten Island workers’ compensation lawyer may be able to challenge the findings and report.
Common Roadblocks During the IME Process
The IME process can be confusing and intimidating. Some common challenges include:
- Discrepancies—Inconsistencies between the IME report and your condition or medical history are common. Your attorney can review these discrepancies and challenge them.
- Inconsistency traps—An IME physician may ask the same question about your condition in different ways to see if the answers change.
- Bias—Because the IME doctor is paid by the insurer, their professional opinion may lean toward supporting the insurance company’s position on your workplace injury.
- Pre-existing conditions—An IME doctor will ask you about past injuries or illnesses, which can be used to argue that your current condition isn’t work-related.
- Scheduling—Delays in scheduling an IME or failing to providing the report to all parties in a timely manner can slow down your workers’ compensation claim.
It’s important to understand that your own actions can lead to an unfavorable IME as well. Insurance companies may be watching you in real life and online, so be careful not to say, do, or post anything that could be used against you. Changing your story, exaggerating your symptoms, or providing more information than necessary can also jeopardize your claim.
Preparing for an IME
If you’re facing an IME, it’s vital to have an experienced attorney help you prepare and anticipate potential challenges. Our team meticulously reviews the medical evidence the IME doctor will receive to anticipate the focus of the examination and prepare you for specific questions.
What to Say
- Focus on function. When describing your injury, focus on your limitations, such as “I can’t bend over and pick something up off the floor,” rather than just saying something like “my lower back hurts a lot.”
- Be consistent. When recounting your injury and treatment, make sure to use accurate dates and details that match your medical records. Your workers’ compensation lawyer will review them with you before your appointment.
- Be concise and courteous. Answer the IME doctor’s questions directly and truthfully. Do not volunteer any extra information unless you’re asked. Be polite, but avoid engaging in casual conversation.
What Not to Say
- Avoid minimizing or exaggerating. Minimizing or overstating your symptoms or the extent of your injuries can derail your claim. For example, if you’re experiencing moderate pain in your back, don’t say that you have none. On the other hand, overstating the severity of your symptoms can result in inconsistencies and lead to an unfavorable IME report.
- Do not discuss anything but your health. Avoid discussion about your attorney, past legal matters, settlements, or grievances with your employer or their insurance carrier. This is all irrelevant to the IME and may result in a biased report.
- Never say you can if you can’t. If the IME evaluator asks you to perform a task that you know will cause physical pain, don’t push through it. Stop as soon as it hurts and clearly explain how it feels.
Manage Your Behavior
- Keep a neat appearance. Make sure that the way you look reflects the seriousness of the situation by dressing appropriately.
- Be attentive. Pay attention to each question and every test the IME doctor performs. Make notes as soon as you can after leaving your appointment. Include details such as the time, location, duration of the exam, questions you were asked, and the tasks or tests the doctor asked you to perform.
- Mind your behavior. IME doctors and staff will observe your actions as well. Arrive on time and be mindful of how you walk into a room, get up from a chair, and ensure any other movements and actions align with your reported limitation.
How Our Staten Island Workers’ Compensation Attorneys Can Help
Not only does our team prepare you for your IME, we take care of everything that comes after as well, including:
- Reviewing the IME doctor’s report and challenging findings if necessary.
- Addressing benefit concerns, such as whether you can return to light duty without losing benefits and how SSDI or settlement offsets may impact your workers’ compensation payments.
- Assisting with appeals and fighting for your rights if your claim is denied or benefits are reduced or stopped.
- Setting accurate expectations about how long your case will take, potential benefits you may receive, the appeals process, and how our contingency fee structure works.
Why Choose Our Trusted Staten Island Workers’ Compensation Lawyers?
- Experience and results you can trust—For decades, our team has successfully helped injured workers in the greater New York City area get the workers’ compensation and Social Security Disability benefits they need and deserve.
- Local focus—As lifelong Staten Islanders, our knowledge and working relationships with the Workers’ Compensation Board, local courts, medical experts, and SSDI offices give our clients a significant edge.
- Compassionate, client-first philosophy—We’re dedicated to ensuring your story is heard and tailor our services to your specific situation. Multilingual attorney and Partner Rolando Cubela proudly serves our Spanish-speaking clients.
- We only get paid if we win your case—Our attorneys take cases on a contingency fee basis, which means you won’t incur any upfront costs or owe attorneys’ fees unless we secure benefits for you.
Contact a Workers’ Compensation Lawyer Near You in Staten Island
If you’re dealing with a workplace injury or IME in a NY workers’ compensation claim, Nappa, Monterosso & Poznansky, LLP can help. Contact us or call 718-273-9000 today to schedule a free consultation with a workers’ comp attorney near you in the greater New York City area.
