Independent Medical Examination
Under the Worker's Compensation Act, s. 102.13, an insurance company or self-insured employer may request that an injured worker submit to reasonable examinations by a physician, chiropractor, psychologist, dentist or podiatrist of its choice. This examination is usually referred to as an independent medical examination.
When compensation is claimed for loss of earning capacity, the insurance company or self-insured employer may request that the injured worker submit to reasonable examination(s) by a vocational expert of its choice.
An independent examination may be requested by the insurance company or self-insured employer in order to determine compensability, the extent of disability, necessity of treatment and type of treatment, and to evaluate permanent disability or loss of earning capacity. Because the injured employee is not a patient or client of the independent examiner, no patient-physician or patient-client privilege exists.
The Department generally considers as reasonable one independent examination every six months. Additional independent examinations, however, may be requested if there is a substantial change in an injured worker's medical condition; for example, the injured worker has surgery. The insurance company or self-insured employer must schedule additional independent examinations with the same practitioner, unless permission is granted by the Department to change independent examiners.
The insurance company or self-insured employer may choose any independent examiner within a 100 mile radius of the injured worker's primary place of residence. If the injured worker is treating with a practitioner whose office is located more than 100 miles from the injured employee's primary place of residence, the insurance company or self-insured employer may require the injured worker to submit to an independent examination in the area where the injured worker's treating practitioner is located.
The insurance company or self-insured employer is responsible for the costs of the independent examination. The insurance company or self-insured employer must make payment in advance to the injured worker for all expenses, including transportation, meals, lodging and wage loss, necessary to attend the independent examination. The injured worker is entitled to full wage replacement, rather than the temporary disability rate, for all time lost from work to attend the examination. The mileage reimbursement must be for the total round trip miles.
The request for an independent examination must be in advance and in writing and must notify the injured worker of the following:
- The proposed date, time and place of the examination and the identity and area of specialization of the examining physician, chiropractor, psychologist, dentist, podiatrist or vocational expert.
- The procedure for changing the proposed date, time and place of the examination.
- The injured worker's right to have his or her physician, chiropractor, psychologist, dentist or podiatrist present at the examination, at the injured worker's expense.
- The injured worker's right to receive a copy of all reports of the examination that are prepared by the examining physician, chiropractor, psychologist, dentist, podiatrist or vocational expert immediately upon receipt of these reports by the insurance company or self-insured employer.
- The injured worker's right to have a translator provided by himself or herself present at the examination if the injured worker has difficulty speaking or understanding the English language.
Upon receiving the required, written notification from the insurance company or self-insured employer, the injured worker must submit to the independent examination. If the injured worker unreasonably refuses to submit to the examination or in any way obstructs the examination, an administrative law judge in the Worker's Compensation Division, may bar compensation during the period of refusal.