What is the difference between an IME and a DME?
Sometimes we first hear from a potential Nebraska workers’ compensation client after they receive a notification for an Independent Medical Exam, or IME.
The injured employee is right to be concerned.
First things first, the term “IME” is not accurate. This is exam is actually a “DME” – or defense medical exam. The insurance company chooses the examining doctor for a DME. You have no say in this selection and generally you MUST attend.
Why a DME?
When insurance companies don’t want to spend money for proposed or continuing treatment for an employee, they pay for a non-treating doctor to give a second opinion. This doctor examines the injured worker, or reviews the medical records, or both. Usually, the notification for an DME occurs after an employee’s treating physician proposes an expensive surgery, scan, course of treatment, or more time off work.
They pay a hefty fee to this doctor, and often the result is an opinion that conflicts with the decisions of the employee’s treating physician – and then a denial of treatment and benefits.
Questions the insurance company might ask the DME examiner include:
• Did the injury occur in the course of employment?
• Is past or current treatment necessary and appropriate?
• Is the employee able to perform any gainful employment temporarily or permanently?
• What physical restrictions, if any, would be imposed on the employee’s employment?
• Has the employee reached maximum medical improvement?
• What is the existence and extent of any permanent physical impairment?
Prior to a DME it helps to have an attorney in the injured worker’s corner. An attorney can help the employee prepare for the examination and fallout. It is helpful for the employee to review all medical history and treatment prior to the exam to avoid inadvertent inconsistencies. It is important to be polite and to not exaggerate symptoms for the DME, but there are boundaries the examining doctor should not cross. An attorney can draw those lines before the exam.
Rarely, a DME expert will agree with the treating physician’s diagnosis and treatment. This is a great outcome, as it is difficult for an insurance company to argue with their own expert.
Usually, a DME expert will disagree with the treating physician. An attorney can counter this by pointing out inconsistencies in the report, gaps in the treatment records, or by requesting a report by another physician.
There is such a thing as an actual IME – independent medical exam. In Nebraska, if a party requests an expert’s medical opinion through the Nebraska Workers’ Compensation Court, they can ask the other party to agree on an Independent Medical Examiner or ask that one be appointed by the court. While the employer’s insurance agency still pays for the exam, they do not get to choose the examiner. Both sides submit questions and records to the examiner.
Whether an DME or an IME, there is a dispute as to treatment or status of an injured worker. If you receive notification of a second opinion, make sure there is someone fighting for you.
