If you have been injured at work and are pursuing a Pennsylvania workers’ compensation claim, at some point the workers’ comp. insurance company for your employer will require you to attend an independent medical examination (an IME, for short) with a doctor of its choice. At the IME, the doctor will start by asking you how you injured yourself, what job you were doing, the treatment that you have received, and your current complaints (this is called taking a history). The doctor will then examine you. The doctor will also review records of other medical providers you have seen for your work injuries, as well as diagnostic studies, such as MRIs and EMGs, that you have undergone. The doctor may also review other materials sent to him by the insurance company such as your deposition testimony. The final and most important step is the doctor will prepare a report summarizing his evaluation and rendering opinions on your Pennsylvania workers’ compensation claim: What injuries did you sustain as a result of the work incident? Have you fully recovered from your injuries? Are you able to return to the job you were doing at the time of your injury, or if not, a lighter-duty job?
Based on the opinions that the doctor renders in the IME report, the insurance company’s lawyer may file a petition against you. If the IME doctor says you are fully recovered from your injuries, the insurance company will file a Termination Petition and try to stop your benefits — both your lost wages and medical benefits (if you are receiving them). If the doctor renders the opinion that you have not fully recovered but can return to your regular job, your employer may send you a letter requesting that you return to work and if you don’t, the insurance company will likely file a Suspension Petition, seeking to cut off your wage loss benefits. If the IME doctor states that you haven’t recovered and am not able to perform your pre-injury position but can return to lower paying, light-duty work, the insurance company may file a petition to modify your benefits — reduce the amount of your wage loss benefits. Any petition that the insurance company’s lawyer files will get heard by a Workers’ Compensation Judge, who will hold a series of hearings and then issue a decision, granting or denying the insurance company’s petition.
It’s almost certain that you’re going to disagree with the opinions rendered by the IME doctor because while an IME is characterized as “independent,” these doctors are typically biased in favor of the insurance company. The doctor may say that you have recovered completely from your injuries and can go back to your physically demanding job when you know for sure that you have not recovered and can’t possibly return to work. You will really be infuriated if the Judge accepts the opinions of the IME doctor over your treating doctor and terminates, suspends, or modifies your benefits. You will wonder how the Judge could possibly accept the opinions of a doctor who saw you one time for a short evaluation over the opinions of your doctor who has treated you for an extended period of time.
If the Judge rules in the insurance company’s favor, you might be so mad that you want to sue the IME doctor for defamation. After all, you may feel that he made false statements in his IME report about your medical condition and ability to work that led to your benefits being cut off. You have lost thousands and thousands of dollars as a result of his false statements and strongly think that the doctor should pay you money in a lawsuit.
We understand how this could make you angry and you want to hold the doctor responsible. Here’s the problem, though. Pennsylvania workers’ compensation law provides that to prevail on a defamation claim, you must establish many elements; first and foremost, you must prove that a person intentionally or negligently made false statements of fact that caused you harm and were published – in other words, the statements were disseminated to a third party. The doctor’s report was clearly provided to third parties (you, your lawyer, the insurance company, the Judge) and you suffered harm because your workers’ comp. benefits were stopped. According to Pennsylvania law, the hurdle that you will not be able to get over is establishing that the doctor intentionally or negligently made statements of fact. Our courts have determined that because an IME doctor is rendering opinions on an injured worker’s medical condition and ability to work, your defamation lawsuit would be dismissed. Opinions cannot be defamatory.
It’s frustrating because the IME doctor’s mindset going into the Independent Medical Evaluation, before he laid eyes on you, well could have been that you have fully recovered from your work injuries and/or can return to work. After all, if the doctor renders these opinions, the insurance company will likely file a petition against you and then the doctor will be paid several thousand dollars to give a deposition.
If you receive a report from an IME doctor that you believe is wrong and unfair, your best course of action is not to sue the doctor but to hire the firm of Pearson Koutcher Law to represent you in your Pennsylvania workers’ compensation claim. Each of our lawyers has more than 25 years’ experience representing injured workers. When the insurance company’s lawyer takes the deposition of the IME doctor, one of our lawyers will be able to challenge his opinions by vigorously cross-examining him. We will ask questions like: You only spent 15 minutes evaluating my client, right? You have been doing IMEs at the request of workers’ compensation insurance companies for many years and do several IMEs a week, right? You’re the only doctor who has found my client fully recovered from her work injuries – all of my client’s treating doctors have not found her fully recovered and have not released her to work, right? Our goal will be to make the IME doctor look as biased as possible and show the Judge that his opinions are incredible and should not be believed.
If you’re injured at work, whether you have been evaluated by an IME doctor or not, please call Pearson Koutcher Law for a free, comprehensive evaluation of your PA workers’ comp case.