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  1. #1
    Join Date
    Dec 2008
    Posts
    10

    Default IME vs 2nd Opinion

    I was told by my orto doctor that I need surgery on my knee. And the I/C adjuster said he wants to send me for a 2nd opinion. My case manager nurse told me that I am going for an IME not a 2nd opinion. Whats the difference? Would'nt both the IME and 2nd opinion give the same treatment solution?

  2. #2
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: IME vs 2nd Opinion

    a second opinion would be a doctor your or your physician chose; an IME is one the employer/carrier chose.

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: IME vs 2nd Opinion

    In Georgia, an injured worker, after a compensable injury, and within 120 days of receipt of any income benefits, shall have the right of one examination...etc...

    This Independant Medical Examination shall not...etc...
    see page 4 here...http://sbwc.georgia.gov/vgn/images/p...delines_mp.pdf

    "IME's" in GA, are used to settle medical disputes...
    If your treating physican requested a 'second opinion' for a proposed surgery, that would be reasonable...It would appear the CA is using the IME because the surgery/requested treatment is in dispute...

    an IME is one the employer/carrier chose
    Actually, either party can request an IME exam...

  4. #4
    Join Date
    Dec 2008
    Posts
    10

    Default Re: IME vs 2nd Opinion

    Great information. Thanks everybody.

  5. #5
    Join Date
    Nov 2008
    Location
    USA
    Posts
    95

    Default Re: IME vs 2nd Opinion

    Unless there's been a change in the last decade an IME in Georgia breaks down to: a single, once in a case lifetime, WC-paid IME for the injured worker and selected by the injured. The insurer can send the injured worker to as many as often as they wish and the injured worker MUST go to the appointment. Transportation is the WC expense if they send you out of reasonable range.

    Always write your own notes on your assigned IME visits for a record of what went on. Full names and positions of personnel who handle, or speak with, you are extra points. Also, sometimes what isn't discussed or asked is as valuable to note as what was said... A note on how extensive the "exam" was and other details is significant. Was there a list of questions the doc was filling out on you? Ask for a copy or at least make a note of it... Who, What, Where, When and Why -- frames up a fairly neat and complete short report. Also keeps your memory clear on the event... Pain and feeling abused and ordered around to difficult appointments can disintegrate a clear memory of the day -- It's hard to think straight and understand some of what is being imposed on you -- and they don't count on counter-data from your perspective... If and when you see whacky reports in your case papers, sit down and write what you remember went on. You're not trying to pick a fight, just stand up for yourself and retain your dignity in an often brutal and fascistic programmed experience...

    Having been to a few IMEs I've seen from a very strange "neurologist" with unusual "credentials" and licensing orders for alcohol and drug abuse all the way to a "topnotch" fellow (all the right credentials) who was an "inventor" of wierd apparatuses and had this "glint" in his eye... Neither was my cup of tea and I followed up with private health insurance reviews and more "conservative" and comprehensible assessments.

    That non-WC health care coverage is a godsend and I hope many have it for "self-defense" if needed but, I know very well how capped weekly benefits leaves little spare change for the added expense. I know in time my blessings will fade...

  6. #6
    Join Date
    Dec 2008
    Posts
    10

    Default Re: IME vs 2nd Opinion

    I went to the IME yesterday. And I feel satisfied with the results. Due to surgery on my knee 28 years ago I have alot of artritis in the knee joint. But the doctor said that the accident aggrevated the joint. The Doc said that I will need a total knee replacement soon. She said without the injury(accident) I could have been able to get a couple more years atleast out of my knee. She recommended a couple months of p/t to see if strengthening the quad muscle would help releave the pain and limping. I am not out to get rich off of the I/C. I just expect fair treatment from the C/A. Thats gonna be interesting. The C/A that I have is very uncooperative. I'm sure he will try and twist this IME report against me. I feel the report is fair to all parties involved. P/T to get back to work, then in the future a knee replacement at cost to me, which I knew that eventually I was going to need anyway. The claims adjusters need to get real and realize that not all injured workers are scamming the insurance companies. If it were possible to know how many try to manipulate the system it would probably be a small percentage. Thanks to all on this site for giving me input about work comp situations

  7. #7
    Join Date
    Apr 2007
    Location
    Kansas
    Posts
    418

    Default Re: IME vs 2nd Opinion

    I recently had a knee replacement due to a work injury.

    LIke you I also had severe arthiritis in the knee. This was a suprise to me as I had not had a previous injury.

    The insurance did fight me for 2 years on the knee replacement but several doctors said the knee replacement would not be needed now if not for the work injury.

    The judge ruled in my favor and the insurance company paid for the replacement.

    I was sent by the insurance company to a total 9 doctors for IME's. Most of the reports were in my favor.

    Good Luck!

  8. #8
    Join Date
    Aug 2008
    Posts
    8

    Default Re: IME vs 2nd Opinion

    What I found is the IME doctor usually is associated or in someway directly works with the defense. In my case there are 3 opinions from 3 different surgeons who say I need surgery. None of them know one another. Since they all pretty much say the same thing the defense wanted me to go to their doctor. This character spent less than 20 mins. with me and never once addressed the problem. He ignored everything I said. Then he told the defense I was only 15% disabled. I am unable to walk and cannot function with out meds. Come to find out a couple of weeks later, this doctor not only specialized in something completely different than what my injury is but he is retired and only works for a couple attornies and insurance companies.

  9. #9
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: IME vs 2nd Opinion

    What I found is the IME doctor usually is associated or in someway directly works with the defense.
    "IME" gets confusing... in some states an IME is an Independant Medical Evaluator...and is supplied by the state medical unit.
    In some states the IME is an "Insurance Medical Evaluation'', and as you suspect, works for the ER/IC...and obviously will have a opinion biased toward the defense.
    In which case, generally you are entitled to your own "IME" evaluation, and/or a hearing on the issues at hand.

    Come to find out a couple of weeks later, this doctor not only specialized in something completely different than what my injury is but he is retired and only works for a couple attornies and insurance companies.
    There are many doctors who either retire, or practice mainly as med/legal evaluators...IME, QME, AME. There are many doctors who rent space in other physicans offices, and/or even in a motel room, in 3, 4, 5 different areas of the state, depending on the rules as adopted by the WC board/commission etc.
    As long as the doctor is licensed to practice medicine, retired or otherwise, the report would be admissable.

    This character spent less than 20 mins. with me and never once addressed the problem. He ignored everything I said.
    Usually there are rules on the amount of 'face time' spent with an IW for a valid medical/legal evaluation. And there should be attention placed on what the IW has to offer.

    BUT, there is no 'patient/treater' relationship in this evaluation...and as a rule, depeding on the reason for the evaluation, the doctor addresses the disputed medical issues as requested. Through the 'face time', and a record review.
    The IME doesn't provide a diagnosis, or develope a treatment plan. That is the responsibility of your treating physican.

    Then he told the defense I was only 15% disabled. I am unable to walk and cannot function with out meds.
    The IME provides a 'opinion' based on his impression of your condition that day. If you/IW disagree with the opinion/report... you take it to the judge.

    IW's are not used to this process because you wouldn't find this procedure when attempting to get treatment under your private health coverage.
    But then WC and your health coverage are not the same, and shouldn't be compared or thought of in the same context.

  10. #10
    Join Date
    Aug 2008
    Posts
    8

    Default Re: IME vs 2nd Opinion

    I read your posting and have a question but it is not related to the case you made the original post for.

    In my situation my attorney set up what he called an IME with a doctor/surgeon other than the one who performed my original procedure. After learning that this doctor says I need additional surgery because the first was not done correctly for what my problem is, the defense scheduled an IME. This doctor who I found out works for insurance companies and attorneys only spent 15 minutes with me. He never addressed my back injury. He looked at my foot and said surgery would'nt help it. I then told him I didn't have a foot injury it was my back. At that time he told me he was done and I was to leave his office. I then get this phone call saying I was to return to work ASAP that I was only 13% disabled. The doctor that has been treating me who I might add was selected by the insurance company has me on 3 different pain medications and agrees with the doctor sying I need surgery on my back again to correct the problem. Since then I have gone to a doctor unknown to the defense or my attorney and just told him I was having some incredible back pain and the other symtoms. His findings after 4 hours, 2 X-Rays and an MRI is, "you need surgery as this was never done correctly to begin with." My attorney says I need to take the settlement and go away and I quote this!

    # 1 - I take 3 painh medications that only partially help with the pain. It makes it tolerable. But I feel as though I am off in another world.
    # 2 - I am unable to lift, bend, squat, kneel, climb stairs, sit for more than 10 mins., stand for more than 15 min., walk more than 20ft and that's if I can at all and if I can it's with a cain.

    Any advise? My attorney can't seem to offer any nor can I get a return phone call or an email.

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