An IME Doctor Just Claimed My Injury Is Not Work-Related: What Happens Now?
After suffering an injury on the job in Vermont, the insurance company may require you to attend an Independent Medical Examination (IME). Unfortunately, sometimes, the IME doctor comes back with a report saying the injury is not work-related. When this happens, it may feel like your workers’ compensation claim is over. But the good news is that, in Vermont, a negative IME opinion does not automatically mean the end of the road. There are important legal steps you can take to protect your benefits and fight for the compensation you need.
What Is an IME and Why Do Insurers Rely on It?
In Vermont workers’ compensation cases, insurance companies are allowed to require injured employees to undergo an IME with a physician of their choice. The aim is to obtain an opinion on diagnosis, causation, treatment needs, or work capacity.
However, while an IME is supposed to be an “independent” evaluation, the reality is that they are not truly independent. IMEs are commissioned and paid for by insurance companies, often, to justify reducing or denying benefits, especially when the physician concludes that the injury is not work-related.
What Happens After an IME Doctor Says an Injury Is Not Work-Related?
If, after an IME, the doctor says that your injury is not work-related, the insurance company may:
- Try to stop your wage replacement benefits
- Refuse to cover additional medical treatment
- Dispute your claim
How To Challenge an Unfavorable IME Finding in Vermont
Here are the steps to take in Vermont to protect your rights after a negative IME opinion:
- Review the IME Report
Request a copy of the IME report and carefully analyze it. Compare the findings with your treating physician’s records to identify inconsistencies, omissions, or false information. If the IME doctor ignored key details about your job duties, medical history, or the incident, this could be grounds for challenging the opinion.
Look for things like:
- Not taking into account your treating doctor’s findings
- Lack of enough evidence to support the opinion
- Incorrect assumptions or conclusions about your condition
- Lack of important test results or diagnostic images
- Gather Evidence
To strengthen your case, it’s crucial to gather solid evidence. This includes:
- Medical records from your treating doctor
- Witness statements from people who saw the injury or accident happen
- Employment records detailing your job duties
The more thorough and detailed your evidence, the stronger your case will be during the dispute resolution process.
- File Form 6
In Vermont, you can file a Form 6 (Notice and Application for Hearing) with the Department of Labor (VDOL) to initiate the dispute resolution process if the insurance company uses the IME report to cut off or deny benefits.
After filing the form, the VDOL will usually arrange an informal hearing, often conducted via phone, to allow both parties to discuss the issues and try to reach a resolution. If a resolution is not achieved, you may move on to a formal hearing where you can present evidence and call witnesses.
- Consider Hiring an Attorney
When challenging an IME report or a denied claim, an attorney can significantly improve your chances of success. An attorney can help you navigate the complex legal process, gather and present evidence effectively, and ensure your rights are protected.
Contact Sluka Law
If you’ve received a negative IME report, contact a skilled Vermont workers’ comp lawyer at Sluka Law PLC today to protect your rights.
Source:
labor.vermont.gov/sites/labor/files/doc_library/Form%206%20%E2%80%93%20Notice%20and%20Application%20for%20Hearing%20%E2%80%93%20rev%209-11.pdf
