Independent Medical Exams (IMEs) and Company Doctors
The Pennsylvania workers' compensation system has a lot of rules, and one of the first ones you will encounter has to do with doctors.
After you're hurt at work, there are guidelines about which doctor can examine you and when. This affects whether or not your employer's insurance company will pay for your initial medical treatment. There are also guidelines about what you can do if you disagree with a doctor's assessment of your medical condition. This affects whether or not you receive workers' compensation benefits.
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- And more
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When Must I See a Company Doctor?
When your employer has a "panel of doctors" posted at your work site, you must see one of these physicians for the first 90 days in order to receive any workers' compensation payments for your medical bills. These doctor visits are called Independent Medical Exams (IME).
Independent Medical Exams
Your employer's insurance company pays for Independent Medical Exams, as well as the physician who does the exam. Unfortunately, it's quite common for a company doctor to tell you that you're no longer injured and can return to work, even if you don't think you're ready.
At any point during treatment with a company doctor, you have the right to refuse to have an insurance company representative present during your medical examinations.
You also have the right to seek a second opinion and to have your employer's insurance company pay for that visit if the company doctor recommends extensive or invasive surgery. However, if the doctor who gives the second opinion recommends any medical treatment, it must be carried out by the company doctor within the first 90 days of treatment.
Your employer CAN request that you see a company doctor every 6 months while you receive workers' compensation benefits.
After 90 Days Have Passed
After the first 90 days, you can choose to treat with your own personal doctor, chiropractor, or another medical professional, as long as you notify your employer's insurance company within 5 days of this change.
No List of Company Doctors Posted
If your employer doesn't have a "panel of physicians" posted anywhere at work, you have the right to choose your own physician and receive payments for medical bills from the start.
What if the Company Doctor Says I Can Return to Work?
If the company doctor says you are ready to return to work or to do a light duty job, you have two options:
1. You may agree with the company doctor and go back to work.
2. If you feel you are still too injured to return to work, you may disagree with the physician. If you don't go back to work, chances are your employer will file a Petition to Terminate, Modify, or Suspend your workers' compensation benefits. You'll have to go before a workers' compensation judge to decide if your compensation benefits should continue.
This can become a lengthy process that is complicated from start to finish. It's best to consult with a Pennsylvania workers' compensation attorney before your payments stop to protect your rights.