The Impartial Physician Examination

Massachusetts legislators adopted the impartial medical examination (IME) method as part of workers' compensation procedures. The examination is meant to eliminate contradictory medical reports between injured workers and their employers. During an IME, a doctor examines the injured employee and evaluates their medical records. After the exam, the doctor writes a report and determines:

• If a disability exists 
• If the disability is total or partial
• If the disability is permanent or temporary
• If the disability occurred during the employee's work

The IME reports have "prima facie" weight, which means that the judge takes them at face value and rarely considers other medical evidence on the subject.

If you become disabled as a consequence of a working injury or illness, you might be eligible for workers' compensation benefits. Workers' compensation law in Massachusetts guarantees that all employers offer coverage to their employees for workplace accidents. If you had a workplace accident, you may be eligible for financial compensation for lost wages, medical treatment, and other benefits.

In order to determine your eligibility for benefits, a medical test is required to examine your injuries or sickness. Your employer’s insurer may send you to one of their providers for an impartial insurance medical exam (IME), which is paid for by the insurance company. The IME is used by the insurer to assess the severity of your impairment, and determine if therapy is necessary. You aren’t required to continue visiting the insurer's provider for medical treatment. However, if the IME is made available to you, you must go to the insurer's recommended provider for the examination. After the IME, you can receive therapy from the provider of your choice.

If there is a disagreement over your eligibility for benefits, both you and your insurer must go to the Department of Industrial Accidents (DIA). In a worker’s compensation appeals case, the DIA settles the disagreement. The appeals procedure involves many parts. It involves a conciliation meeting with a DIA mediator, a conference with an administrative judge, and a hearing if one of the parties challenges the court's conference order. While the insurer will use the IME to evaluate whether you are eligible for benefits, the administrative judge will use an impartial physician examination (IPE) at the hearing to determine whether or not your impairment is work-related and how severe it is.

An IPE is a medical examination done by an unbiased physician to determine the existence and degree of a worker’s disability. It may involve a physical examination or a review of previous medical data. IPEs are carried out by doctors who are members of the DIA's Impartial Physician Program. The DIA has built a list of unbiased physicians to conduct evaluations of the injured workers’ medical conditions.

In an appeal, the administrative court must base their decision on the medical evidence's strength. Following the worker’s IPE, the physician will provide a written report to the judge. Both the worker and the insurer have the right to question the physician who performed the IPE. However, the law prohibits any other physician's medical report or deposition from being used in court. Additional medical evidence may be included by the judge only if the physician's report is inadequate.

While the insurer usually pays for the IME, the party appealing the judge's conference order pays for the IPE. Among the expenses are a $650 examination charge, a $750 deposition fee for a maximum of two hours (plus $150 per hour for up to two extra hours), and a $300 fee for a review of your medical records without an examination.

Bellotti Law Group P.C.'s attorneys represent disabled workers in the Boston area. If you or a loved one was injured on the job, or you were ill as a result of your workplace conditions, you will need representation to make sure your claim for workers' compensation benefits is successful. If your claim is denied, our attorneys can appeal your claim. We have handled several DIA appeals, and we will examine and challenge a physician's conclusions. To schedule a consultation, call our legal firm now for the help you need. Call 617-225-2100 for a free consultation today.