When an employee is hurt on the job, worker’s compensation insurance covers certain benefits, including medical care to cure and relieve the effects of the injury. And while it seems that medical benefits should be easy to obtain, that is not always the case. Workers’ Compensation insurance carriers pay medical benefits based on three criteria. First, the injured worker must go to an authorized or designated medical provider. In Colorado, the employer has the right to designate the physician. Second, the medical treatment must be related to the original injury. Third, the medical treatment recommended must be reasonable and necessary.
Frequently medical treatment will be recommended which the insurance carrier questions whether “reasonable and necessary. For instance, if an injured worker hurts a knee, the orthopedic doctor might recommend knee surgery, such as a meniscus repair. If the insurance carrier does not agree that the surgery is reasonable and necessary, it will schedule an independent medical evaluation. Again, the insurance carrier in Colorado has the right to designate which doctor will perform IME. The purpose of the IME is for the physician to give an opinion whether the proposed medical treatment is reasonable and necessary.
While that sounds simple and straight-forward, it is not always that way. The insurance company quite often does not have your interests in mind. Rather, it will designate a physician to perform the IME who is known to be “Conservative”.
Some tips for when you attend an independent medical exam, or IME:
Attending an IME requested by the insurance company can be stressful. However, if you take your time and follow the tips outlined above you will do better than if you go unprepared.