What is an Independent Medical Examination (IME) in Arizona Workers' Compensation?

Understanding Independent Medical Examinations (IMEs) in Arizona Workers' Compensation

If you're an injured worker in Arizona, you might encounter the term "Independent Medical Examination" or "IME." This blog post aims to clarify what an IME is, why it's performed, and what your rights and responsibilities are during this process within the Arizona workers' compensation system.

What is an Independent Medical Examination (IME)?

An Independent Medical Examination (IME) is a medical evaluation of an injured worker conducted by a doctor chosen by the defendants, typically your employer or their insurance carrier. It is important to understand that an IME is not a source of treatment; rather, it is a claims management tool that allows the workers' compensation provider to assess your medical condition and treatment needs from a source independent of your treating physician. The physician conducting the IME has the role of providing an independent, unbiased assessment of your medical condition, its effect on your function, and any limitations on your daily living activities.

Why is an IME Requested?

Employers or insurance carriers request IMEs to monitor the quality and necessity of your medical care. They use these examinations to understand the character and extent of your injury and to evaluate your treatment and condition from a physician who is not your primary treating doctor. This is part of their process to secure opinions on various issues that arise during your workers' compensation claim.

Your Responsibilities Regarding an IME

As an injured worker, you have certain obligations concerning IMEs:

• You must attend an IME if you receive a "Notice of IME," unless you are officially excused.

• You are expected to submit to medical examination from time to time at a place reasonably convenient for you, if requested by the Industrial Commission, the State Compensation Fund, your employer, or the insurance carrier.

• You must not obstruct the examination.

  
  

Your Rights During an IME

While you are required to cooperate with an IME, you also have specific rights:

• Notice: You must be sent a notification of the time, place, and person conducting the IME at least 15 days before the scheduled examination.

• Presence of Your Physician: You may have your own physician present at the examination, provided you procure and pay for their presence yourself.

• Recording the Examination: You are entitled to audiotape the examination as an alternative to having your own physician present. However, you are not allowed to videotape the examination. Generally, you are not entitled to have other individuals like a spouse, family member, or friend present in the examination room unless they are your personal physician.

• Protective Orders: If you believe an IME is unnecessary, cumulative, or could be scheduled more conveniently where you reside, you may file a motion for a protective order. This motion should be filed with a copy sent to the defendants' lawyer, stating your reasons for wanting to be excused. However, you will not be excused simply because you dislike the chosen doctor or believe your own doctor has provided sufficient information.

• Travel Expenses: If you are directed to report for an IME in a location other than your current place of residence or employment, the carrier, self-insured employer, or special fund division shall pay your reasonable travel expenses in advance, including transportation, food, lodging, and loss of pay. Travel expenses are considered medical benefits.

• Receiving the Report: The carrier, self-insured employer, or special fund division is required to provide you (or your authorized representative) with a copy of the IME report immediately upon receipt. If you are unrepresented and the IME examined your mental condition, the report may be provided to your treating physician instead.

Consequences of Non-Compliance

Failing to attend an IME can lead to serious consequences, including your request for a hearing being dismissed and/or the suspension of your workers' compensation benefits. If you refuse to submit to or obstruct an examination, your right to compensation will be suspended until the examination is completed, and no compensation will be payable during that period. This suspension is usually triggered by a "willful act" on your part. Additionally, if you unreasonably fail to attend or notify of your inability to attend, the party requesting the examination may charge you or deduct the cost of the missed appointment from any present or future temporary or permanent disability compensation.

Important Considerations for Injured Workers

Arizona's workers' compensation system is designed as a "no-fault" system to provide benefits to injured workers. However, it is a complex legal area. While you are not legally required to have an attorney to represent yourself, the employer or carrier may be represented by an attorney specializing in workers' compensation law. If you choose to represent yourself, you will be expected to be familiar with and follow the laws and rules that apply to your case. The Industrial Commission Ombudsman can provide general information about the system and hearing process, but they do not provide legal advice.