Independent Medical Examinations vs Functional Capacity Evaluations
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Why Would You Need an Examination?
If you are involved in a personal injury, workers’ compensation, or disability-related claim, you may undergo independent medical examinations (IME) or functional capacity evaluations (FCE’s). While both types of examinations focus on your medical conditions and limitations, they serve different purposes. You should know what to expect before you attend an IME or FCE.
What Is an Independent Medical Examination?
An independent medical examination (IME) is a medical examination performed by a “neutral” doctor. Unlike a treating physician, an IME doctor does not provide medical treatment. Instead, IME doctors perform a one-time exam and determine:
- The need for additional medical treatment,
- Whether work restrictions are appropriate,
- Whether an accident caused an injury or medical condition, and
- Whether a claimant is disabled.
Although an IME is supposed to be neutral, insurance companies and lawyers typically hire doctors who support their arguments. IME reports are frequently used as evidence in a disputed personal injury or workers’ compensation claim.
While some IME’s are detailed and time-intensive, many are relatively short. The doctor will ask you questions, perform an examination, and evaluate your medical conditions. You may be able to have a witness present during the exam, depending on your state’s laws and the type of claim.
After the examination, the IME doctor will write a report setting out:
- Your diagnoses,
- Suggested work restrictions,
- Recommended treatment, and
- Whether your accident caused your injuries or medical condition.
Again, the IME report is only one doctor’s opinion and may not be completely accurate. Unfortunately, the insurance company may use the IME report as a reason to terminate benefits or deny your claim. If your benefits are denied after an IME, you may have appeal rights. An experienced lawyer can help you evaluate your claim and file an appeal.
What Is a Functional Capacity Evaluation?
A functional capacity evaluation (FCE) is a series of tests that evaluates your ability to work. An occupational or physical therapist will guide you through the tests and assess your effort and abilities. An FCE is considered an objective (fact-based) exam.
Unlike an IME, where the doctor gives an estimate or opinion, an FCE specifically tests your capabilities. It is a much longer examination, typically lasting several hours. During an FCE, you will be asked to:
- Walk and run,
- Grip and grasp,
- Handle and carry objects,
- Climb, and
- Perform other work-related activities.
Depending on your case, the therapist may either assess your ability to perform your specific job or all types of work.
An FCE report is typically longer and more detailed than an IME report. It often lists specific activity tolerances. (For example, the report may state that you can lift 20 pounds occasionally, walk 100 feet without assistance, but need breaks every 30 minutes.) Based on these limitations, the therapist will indicate your ability to return to work.
You should provide a full effort during an FCE, since the therapist may report your test invalid if you exaggerate your symptoms. However, you should report increases in your pain and may request breaks when needed.
Can I Skip an IME or FCE?
No. Unless there is an emergency, you must attend an IME or FCE. Failure to attend an examination is grounds for a termination of your benefits (or a denial of your claim). However, there are some limitations to this rule. For example, you reasonably request a rescheduled exam if:
- The insurance company does not give you enough notice,
- The insurance company fails to send you a mileage check, or
- You have good cause and give the insurance company enough time to reschedule.
If you are having problems with IME or FCE scheduling, you may want to contact a lawyer. A lawyer can help you reschedule the exam and protect your rights.
Additionally, you should always be honest with an IME doctor. Do not exaggerate or minimize your symptoms or history. Insurance company IME doctors are looking for reasons to discredit you. Any exaggeration will be considered malingering in an IME report. However, if you minimize your symptoms, the IME doctor may report that you no longer need medical treatment and may return to work.
I’m Scheduled for an IME or FCE. Do I Need a Lawyer?
Yes. An IME or FCE is a sign that the insurance company may deny your claim. A personal injury lawyer can prepare you for the IME process and may know the information about your IME doctor’s personality and tendencies. A lawyer can also file an appeal and prepare your case for trial if your claim is denied.
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Last Modified: 10-10-2016 09:39 AM PDT
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