The Role of a Doctor in a Workers’ Compensation Claim

When it comes to on-the-job injuries, employers and their workers’ compensation insurance companies have several responsibilities. One of the most important of these obligations is assisting the employee in obtaining necessary medical treatment from a qualified physician. At some point in the case, the employer or its workers’ compensation insurance carrier may also ask the employee to see another doctor at its expense – a doctor who will perform a so-called “independent medical examination” or “IME.” Unfortunately, IMEs do not tend to be “independent” at all, since they are performed by doctors who are chosen because of their tendency to side with the company on the various issues that are pertinent to the resolution of a work injury case. At the Law Firm of Valerie J. Crown, Attorney at Law, P.C., our Rockland County workers’ compensation lawyer can help you understand the role of a doctor in a workers’ compensation claim, including the IME process.

The results of IMEs can vary widely, depending on the employer, the workers’ compensation insurance company, and the particular physician who is performing the evaluation. While there are some doctors who make an effort to conduct an honest, fair-minded examination of an injured worker, these medical professionals tend to be the exception rather than the rule. More often, IME doctors can be expected to deliver a report that is much more favorable to the employer than to the employee. Sometimes called “company doctors,” many IME physicians spend much of their time and earn much of their salary performing evaluations at the behest of insurance companies. Some may not even practice medicine on a regular basis in New York.

After a worker has given notice of a work-related illness or injury and begun seeing a treating physician, that doctor may place the worker on light duty or may say that the worker is temporarily totally disabled. This, in turn, triggers an obligation for the employer or the workers’ compensation insurance company to pay disability benefits. Expensive medical treatment, such as tests or surgery, may also be ordered by the treating physician. In response to this situation, the employer/insurance company may ask the worker to see another doctor – an IME doctor – whose opinion may differ.  As a result of the IME, the employer may reduce or terminate disability benefits or refuse to authorize certain medical treatment. An IME doctor may also weigh in on the issue of whether the employee has reached a point of maximum medical improvement and, if so, whether he or she suffers from any permanent physical disability as a result of the work-related accident or illness.

Fortunately, the employee is not without recourse. He or she has a right to seek a separate evaluation from a different doctor. If the second physician’s opinion is different from the first (which often happens), the employee may submit that doctor’s report to the New York Workers’ Compensation Board to be considered along with the employer’s IME report during the determination of the issues in the employee’s claim. There may be a hearing in front of an administrative law judge, and both doctors may testify via telephone deposition. Once a decision is made by the administrative law judge regarding the compensability of the claim, the need for certain medical treatment, and the extent of any vocational disability suffered by the worker, there may be an appeal by one or both parties, and a review panel may issue a different opinion.

If you want to find out more about the role of a doctor in a workers’ compensation claim, the Law Firm of Valerie J. Crown, Attorney at Law, P.C., can be reached at 845-708-5900 or at 845-598-8253 (Valerie’s personal cell phone). Our firm assists injured workers in Rockland County and throughout the greater New York City area. We offer a free consultation and do not require clients to pay any fees up front.