What You Should Know About IMEs in Florida
The first thing you should know about an IME in Florida is what this acronym stands for. Independent Medical Examinations are part and parcel of many workers’ compensation claims in many jurisdictions. IMEs are especially critical in states like Florida that don’t allow most job injury victims to choose their own doctors. The primary purpose of an IME is to obtain an objective medical opinion regarding an individual’s injuries, diagnosis, treatment, and overall level of impairment.
A good IME usually begins with a good Tampa workers’ compensation lawyer. Attorneys have professional relationships with doctors who focus on work-related injuries and illnesses. Therefore, these professionals are well-suited to properly evaluate claims and carry great weight with the administrative law judges who preside over workers’ comp appeal hearings. As a bonus, these professionals normally charge nothing upfront for their medical and other services.
Medical Benefits
As outlined below, IMEs strengthen medical bill payment claims. Medical bill payment is a central component of the benefits an injured employee is entitled to receive.
In Florida, an employer’s workers’ compensation insurance carrier is generally responsible for paying all authorized and medically necessary treatment costs. This category includes doctor visits, hospital care, diagnostic tests, surgery, physical therapy, prescription medications, and medical equipment.
Once treatment is provided, the medical provider submits the bills directly to the insurance company, which must review and pay them according to state fee schedules and guidelines. Job injury victims are not financially responsible for any unpaid covered charges, such as the difference between an out-of-pocket cost and an insurance reimbursement cost.
Insurance carriers often evaluate whether services were reasonable, necessary, and related to the workplace injury. If a bill is denied or reduced, the provider or the injured worker may dispute the decision through the appropriate workers’ compensation process.
IMEs in Florida
Insurance carriers, employers, and Tampa workers’ compensation lawyers may request an IME when there is disagreement or uncertainty about the nature or extent of a work-related injury. For example, if Dr. X recommends surgery and the insurance company questions the necessity of that procedure, the insurer may request an IME to obtain an independent assessment.
Florida law generally allows each party one IME per case, although additional examinations may be permitted under certain circumstances if supported by good cause.
Nuts and Bolts of Workers’ Compensation IMEs
The physician conducting the IME must be licensed and qualified in the relevant specialty. During the examination, the doctor typically reviews medical records, diagnostic test results, accident reports, and any other relevant documents.
Additionally, doctors usually interview victims regarding the circumstances of the injury, pain levels, medical history, and current limitations. Although the IME resembles a traditional medical appointment, the examiner does not provide treatment. Instead, this physician’s role is to observe, document, and form an unbiased opinion.
After their examinations and investigations, IME doctors prepare reports summarizing their findings. This report often addresses whether the injury is consistent with the individual’s account, whether the treatment being provided is reasonable and medically necessary, whether the person has reached maximum medical improvement (MMI), and what functional restrictions, if any, should apply.
Rely on a Diligent Hillsborough County Lawyer
Injury victims are entitled to important financial benefits. For a confidential consultation with an experienced workers’ compensation lawyer in Tampa, contact Kobal Law. The sooner you reach out to us, the sooner we start working for you.
Source:
myfloridacfo.com/division/wc/employee/return
