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September 7th, 2022

What Can I Do If My Doctor’s Findings and the Independent Medical Exam Disagree?

If you’re injured on the job, we can help you find the right doctor approved by the Texas Division of Workers’ Compensation. The insurer or the Division can also have you examined by a doctor for another opinion. If the two doctors disagree, we can take action to try to correct their findings or show why it’s incorrect.

This process is known as an independent medical exam (IME). It’s mandatory if the state orders it. If you don’t cooperate with an insurance company IME they’ll deny your claim. The insurance company’s goal in setting one up is probably to find grounds to contest your claim. They may hope this other doctor’s opinion is you’re not as impaired as you claim, and you’re able to return to work with or without restrictions.

Why Would an Insurance Company Want an IME?

You should expect an IME if:

  • The insurance company appears to disagree with what your doctor states (it’s not work-related or as severe as claimed)
  • The insurance company denies your claim
  • Your claim costs them a lot of money, so they want to reduce your benefits or limit your medical or rehabilitation treatments

If there’s an IME, don’t assume it will hurt your claim, or it will be denied. It’s a normal part of the comp claim process, but it’s not something you should take lightly. 

Who Will Perform This IME?

The insurance company will probably choose a doctor they’ve worked with before, and they’re likely to take positions that are favorable to the company (though there’s no guarantee). Though the doctor may want to continue to perform IMEs for the insurer, unless there’s a reason to think otherwise, we should assume the doctor is competent and professional. There’s a good chance we’ve encountered the physician in another case.

What Should I Do at the Exam?

When you see this doctor, be honest and cooperative. Don’t limit your injury or how it impacts you, but don’t exaggerate it either. Part of the IME will describe how you interacted with the physician. If it looks like you’re trying to hide something, that will come out in the report and likely impact the findings. 

Answer questions about your treatment, condition, and cause as best as possible. If you don’t know the answer, admit that. If you’re asked about what your doctor thinks, respond by saying that it should be in the copies of your records.

What Will Happen If the IME Results Contradict My Physician?

We will closely review the results. If the doctor didn’t have all of your records or was missing information, we will provide them and ask the doctor to reconsider the findings. Depending on the outcome of the insurance company’s IME, we may schedule our own IME to try to show their IME’s conclusions are incorrect. 

If there’s a difference of opinion between your treating physician and the one hired by the insurance company, it’s generally over how severe your condition, how limited you are, what kind of treatments you should get, and how many. It’s rare that the two doctors completely disagree on an injury, its treatment, and how it affects the person. 

How Can Schechter, Shaffer & Harris L.L.P. Help Me in This Situation?

Whether this issue comes up in the course of negotiating with an insurance company or your claim is the subject of a Contested Case Hearing, we will:

  • Show evidence that contradicts the IME’s conclusions
  • Make arguments why the insurance company’s IME is flawed
  • Establish why your doctor and or our IME is more credible

Whether it’s a workers’ comp or a personal injury case, dealing with conflicting medical opinions is a regular part of our work. Telling our clients’ stories and explaining why they should have the outcome they seek are critical parts of our job. If we didn’t do them well, we wouldn’t have such a successful practice.

Schechter, Shaffer & Harris, LLP Helps Those Severely Injured in Workplace Accidents

Our attorneys have many years of legal experience helping those injured on the job get the benefits they need. Call us at 713-893-0971 today, and we’ll evaluate your case during a free consultation.

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