Key takeaways:
- An unfavorable IME report does not automatically end workers’ comp benefits.
- Insurers may seek to modify, suspend, or terminate compensation after an IME.
- A workers’ comp judge may review medical evidence from both sides.
- Treating physician records can help challenge the IME doctor’s conclusions.
- Injured workers should keep notices, medical records, and job-offer documents.
An Independent Medical Examination can become a turning point in a Pennsylvania workers’ compensation claim. The doctor is selected and paid by the employer or insurer, and the report may address your diagnosis, treatment, work restrictions, and whether you have recovered. However, the report does not automatically end your benefits. Pennsylvania law permits employer-requested medical examinations at reasonable times and places during a claim.
The insurer may continue the claim, offer modified work, or use the physician’s opinions to seek a reduction or termination of compensation. What happens next depends on the report, your benefit status, and the medical evidence supporting your injury. Read on to learn how insurers use IME reports, what happens if a petition is filed, and how a resourceful workers’ comp lawyer in Pennsylvania can work to protect your benefits after an unfavorable evaluation.
Does an unfavorable IME report stop benefits immediately?
An unfavorable report alone generally does not let the insurer simply end accepted wage-loss benefits. The employer or carrier may need your agreement, a legally authorized notice, or an order from a workers’ compensation judge.
When a petition is filed, the Workers’ Compensation Office of Adjudication assigns the case to a judge. You should receive the petition and a Notice of Assignment identifying the judge. The judge can consider medical evidence from both sides before deciding whether compensation should change.
The insurer may also request supersedeas, asking the judge for permission to reduce or stop payments while the case is pending. Missing a notice, hearing, or deadline can make it harder to challenge the report and the relief requested.
Can you challenge the IME doctor’s conclusions?
Your treating physician’s records and testimony may provide the strongest response to an unfavorable IME. The treating doctor should understand the accepted injury, current symptoms, objective findings, job duties, treatment history, and remaining restrictions.
Our analytical attorney may look to compare the report with:
- Diagnostic tests, operative reports, and therapy records
- Earlier medical opinions and work restrictions
- The physical demands of your pre-injury job
- Inconsistencies within the examination or report
- Symptoms or accepted body parts the doctor failed to address
- Evidence that treatment is still helping
Continue attending appointments and following reasonable medical restrictions. Do not perform duties that exceed those restrictions merely because the IME doctor released you. Keep job offers, insurer letters, medical notes, and petition paperwork. The IME physician’s opinion can still be challenged through testimony and other medical evidence during the adjudication process.
Who has the reputation as the best workers’ comp lawyer in Pennsylvania?
If an IME report is affecting your medical care, return-to-work expectations, or wage-loss benefits, the methodical team at Liberty Bell can review the report, compare it with your treating evidence, and respond when the insurer pursues a termination, suspension, or modification.
Whether you’re injured in Philly, Allentown, or another part of Pennsylvania Dutch Country, and you’ve received an unfavorable report or a petition soon afterward, our determined legal team is here to help. We can explain NCP vs. temporary claim acceptance, pursue penalty petitions for insurer violations, protect your partial or total disability benefits, and help you every step of the way.
Don’t feel despondent if you’ve received an unfavorable report or a petition soon afterward. Nothing is lost, and you still have options! Contact us for a free consultation and we’ll challenge unsupported medical conclusions and fight to preserve the compensation your injury requires. Call us ASAP!