Is an Independent Medical Exam Good for your case?

Workers' Compensation Adjuster Wants an Independent Medical Examination

Attorney Kevin P. Holmes June 19, 2019

If the Workers' Compensation Adjuster tells you he or she wants an Independent Medical Exam (IME), you may be in Trouble

Under Workers' Compensation law in New Mexico, if you were hurt at work, you are entitled to disability pay and reasonable and necessary medical care for all injuries caused by the workplace accident.

But sometimes, insurance companies and their adjusters try to find ways to deny a claim by arguing that your injuries weren't caused by the workplace accident.

For example, if you have a pre-existing condition, the adjuster may claim (falsely) that the pre-existing condition completely disqualifies you from receiving workers' compensation benefits.

Other times, while you may not have a pre-existing condition, your injuries may not be straight-forward or simple.

And other times, your injuries and the care necessary to help you recover from them may simply be very expensive.

In these kinds of situations, insurance companies and their adjusters pull a fast one--they either tell you you're required to undergo an Independent Medical Examination or tell you that if you don't agree to one, your claim will be denied. Neither is true.

An Independent Medical Examination (IME) is a medical examination by a doctor or a group of doctors to help answer questions about medical causation in a workers' compensation case. For example, if you have a pre-existing condition and there's a question about whether the workplace accident made it worse, or there's a question about whether the workplace accident had no effect on the pre-existing condition at all, an IME might be a way to get an answer.

But an IME is not mandatory for a worker and is not a condition of receiving benefits, and a worker does not have to agree to it--at least not until a judge orders one.

Under New Mexico Workers' Compensation law, either party may petition the Workers' Compensation Administration for permission to have an IME. If the Judge agrees that an IME is appropriate, the Judge will order one to take place.

In New Mexico, the doctors who typically conduct IMEs are pretty fair. But some are "more fair" to the insurance companies than others, so insurance companies and their adjusters are always trying to convice the judge to have the worker sent to those doctors.

If your insurance company or its adjuster tell you they want an IME, chances are they are looking for an excuse or cover to deny your claim. And if they tell you that you have to agree to one or lose your benefits, chances are they are lying to you to bully you into accepting the IME or giving up your claim to benefits. Neither is appropriate.

If the Insurance Company wants an IME, Call Holmes Law Firm

An experienced workers' compensation attorney can evaluate your case and help figure out whether an IME is appropriate.

If it's not appropriate--either because there are no questions that an IME can fairly answer, or because a simple letter from your treating doctor can answer the questions that may be there--then Holmes Law Firm can help you fight the IME process and move your claim and case forward in a favorable manner.

If an IME is appropriate, having a workers' compensation lawyer on your side will be very important. You'll need experte advice and guidance on how to put your best foot forward for the IME and how to understand what information the doctor (or doctors) requires to get you through the process and moving forward with your claim.

If you suspect the workers' compensation insurane company or its adjuster is looking for an excuse to deny your claim, call Holmes Law Firm today. We'll evaluate your case for free, and if we take you on as a client, there's no up front fee for our services.

We'll fight to get you all the benefits you're entitled to and get between you and the adjuster to make the claim process easier so you can concentrate on getting better and recovering as quickly as possible.