Workers’ compensation claims in South Carolina offer valuable financial assistance for job-related injuries or illnesses, including wage replacement and medical care. Administered by the South Carolina Workers’ Compensation Commission, this program is a critical resource, ensuring injured workers have access to the benefits they need for recovery and support after disabling injuries, whether temporary or permanent.
To qualify for these benefits, you will be examined and treated by a doctor chosen for you by your employer’s insurer. This doctor will assign your injuries an impairment rating. If you or your attorney believe the rating assigned to your injuries is unfair, you might need to undergo an Independent Medical Exam (IME). Read on to learn more about the circumstances requiring an IME for your claim and how our South Carolina workers’ compensation attorneys at Joye Law Firm can guide you through the process to optimize your claim.
What is an Independent Medical Exam (IME)?
An Independent Medical Exam (IME) in a workers’ compensation case involves a medical assessment by an impartial physician, who has not previously been involved in your medical treatment. This is to ensure a fair and unbiased evaluation of your injury.
The IME is a critical assessment that either corroborates or questions your statements about the extent of your injuries. An IME can be requested for various reasons, such as:
- Assessing the injury: IMEs can be used to determine the injury’s nature and extent, and to confirm its connection to your workplace accident or job injury.
- Reviewing current treatment methods: IMEs assess the need for continued medical care and examine existing treatment approaches to verify their suitability for your condition.
- Completing a return-to-work assessment: IMEs can also be used as return-to-work assessments, determining whether you can safely resume work in your previous role or a modified capacity.
When are IMEs Necessary for Workers’ Compensation Claims?
An attorney reviewing your case, or your employer’s insurance carrier, might find it necessary to perform an IME under specific circumstances. The goal of the IME is to guarantee fairness and accuracy in assessing a worker’s injuries and associated benefits. Here are typical situations where an IME might be required:
- Benefit disputes. An IME, or Independent Medical Examination, might be necessary to offer an alternative assessment in cases where there’s a dispute among the injured worker, their primary healthcare provider, and the workers’ compensation insurer about the severity or type of the injury.
- Treatment disputes. If there are doubts about the need for specific medical treatments, surgeries, or therapies, an IME can be instrumental in establishing whether the suggested medical approach is warranted.
- Claim denials. If a workers’ compensation claim is denied, the injured worker’s attorney can pursue an IME to contest the denial and supply additional evidence to bolster the claim.
- Second opinions. Occasionally, the injured worker or the insurance company might pursue an IME as a second opinion to confirm or dispute the initial medical evaluations.
How Can Your IME Affect Your Workers’ Comp Case?
An IME can influence the resolution of your workers’ compensation settlement and ongoing benefits in the following ways:
- Enhances claim legitimacy: An IME can provide medical evidence to reinforce the legitimacy of your claim. This strengthens your legal position for compensation, especially if you were previously denied.
- Increases compensation accuracy: The IME findings can help accurately assess the extent of your injuries. This enables you to receive fair compensation that reflects your current and future medical needs and any disability related to your injury.
- Supports treatment approvals: An IME can confirm the necessity of medical treatments or surgeries, leading to approval of these procedures under your claim. This helps maximize your medical benefits so you get the treatment you need for recovery.
- Influences settlement negotiations: Your attorney can use the results of the IME during settlement discussions to achieve a more favorable financial outcome. and to refute the insurer’s attempts to minimize your compensation.
