Independent Medical Examinations (IMEs) in Workers’ Compensation Cases

The Bureau of Labor Statistics (BLS) reports that more than 34,000 people were hurt while on the job in South Carolina in 2022 alone.

Following a workplace accident, you have the right to seek benefits through a workers’ comp claim. Disputes over workers’ comp benefits can arise for a wide range of different reasons. If there is a conflict regarding a medical issue—such as the worker’s injuries or the nature of their physical limitations—an independent medical examination (IME) may be requested. Within this article, our Rock Hill workers’ compensation attorneys explain the key points to know about the role of IMEs in workers’ comp cases.

Most Employees in South Carolina are Covered By No-Fault Workers’ Comp

In South Carolina, most employees are entitled to no-fault workers’ compensation insurance coverage as a matter of law. The coverage provides certain benefits—medical coverage and wage replacement—to injured workers without any proof that an employer’s negligence contributed to their accident. Coverage under South Carolina’s no-fault workers’ compensation is comprehensive.

Disputes Can Arise Over the Severity of a Worker’s Injuries and Medical Limitations

While most workers in South Carolina are covered by no-fault workers’ comp insurance, that does not mean that a claim will be automatically approved. Quite the contrary, an injured worker could potentially run into issues when trying to claim their benefits.

Typically, workers’ comp disputes in South Carolina fit into one of two categories:

• Coverage Issues: A dispute may arise over whether or not workers’ comp insurance applies. For example, an employer may try to deny a claim because a worker was not on the job when they were hurt.

• Medical Issues: Disputes can also arise over medical issues. An employer may try to deny a claim and/or limit benefits because a worker’s injuries are not as severe as claimed.

What Does IME Mean for Workers’ Comp?

IMEs are for medical-based disputes. The National Institutes of Health (NIH) explains an independent medical examination (IME) is “an assessment performed by a physician who does not treat the patient.” In other words, an IME is an “independent” medical evaluation of an employee. The purpose is to obtain information related to some aspect of a workers’ comp case. An IME doctor may provide a report with a professional opinion regarding:

• The existence of a worker’s injuries;
• The severity of a worker’s injuries;
• The necessity (or lack thereof) of additional treatment; and
• The remaining limitations (or lack thereof) of the worker.

Three Key Points Injured Workers Should Know About Independent Medical Examinations

An “Independent” Medical Examination is something of a misnomer in South Carolina workers’ comp cases. IMEs are generally requested and paid for by the insurance company. They are also likely to select the doctor from their network. Put another way, the process is not as independent as the name suggests. Here are three of the most important things that injured workers need to know about IMEs and workers’ compensation claims in South Carolina:

• You Must Attend IME When Properly Requested to Obtain/Maintain Benefits: If you are an injured worker and an IME has been requested by your employer/insurer, then attending the appointment is generally mandatory. Failing to comply with an IME request can lead to the suspension or denial of your benefits. While it may seem inconvenient, cooperation with this process is essential for maintaining the financial support necessary for your recovery.

• Employers Often Request IME When They are Considering Challenging Benefits: An IME is commonly requested by employers or insurers when there is a question about the accuracy of the initial medical report or the severity of the injury reported. The examination serves as a tool for the insurance company to ensure that the compensation provided is appropriate for the injury’s impact on the worker’s ability to function. If there are discrepancies between your reports and your medical records, or if there is a significant improvement in your condition, an IME might be initiated to reassess your benefits. Be very careful with the IME process. A South Carolina workers’ comp lawyer can help.

• The IME Doctor Does Not Get to Make the Final Decision On Your Benefits: To be clear, it is crucial to understand an IME doctor does not get to make the final decision on your workers’ compensation benefits. Instead, the role of the IME doctor is limited to evaluation and reporting—they do not have the authority to make final decisions. With that being said, their report is still extremely vital. Their assessment is used as evidence in the decision-making process. Even if the IME report is unfavorable, injured workers have the right to challenge the findings and seek a second opinion to support their claim.

The Bottom Line: An IME may be requested in your workers’ comp claim if there is an outstanding question regarding your injury, medical complications, the necessity of additional treatment, and/or your remaining functional limitations. The IME doctor should provide an independent assessment, but they often have financial incentives to support employers/insurers.

Why Rely On Our South Carolina Workers’ Comp Lawyer

A workplace accident can put a dramatic financial strain on an employee and their family. No-fault workers’ compensation benefits can provide some much-needed support. However, in some cases, injured workers may run into issues with their employer and/or the insurance company. At Schiller & Hamilton, we help injured workers in South Carolina navigate the claims process, including any issues related to an independent medical examination (IME). For more information about our services, you can review our client testimonials, and case results, or contact us for a free consultation.

Contact Our Rock Hill Workers’ Comp Lawyers Today

At Schiller & Hamilton, our Rock Hill workers’ compensation attorneys are experienced advocates for injured workers. If you have any questions or concerns about independent medical examinations, we are here as a legal resource. Contact us now for a free, completely confidential consultation.