In 2016, the Ohio Bureau of Workers’ Compensation (BWC) addressed over 88,000 work injury claims. Employees in a wide range of fields across the state experienced illnesses and injuries on the job that required care and days off work. To help ease the hardship associated with the medical bills and lost wages, the state workers’ compensation system offered a variety of benefits. In some cases, the recovery was prompt, and the employees were able to return to work with little delay. In other cases, however, the illness or injury was more severe, and workers were forced to miss a significant amount of work to address these medical needs. While benefits exist to cover these long-term situations, there is often additional steps to take to ensure continued care and compensation. One major component is the completion of an independent medical examination. These exams are required in some cases can have a significant impact on compensation going forward.
What Is an Independent Medical Examination?
The Ohio BWC defines an independent medical examination (IME) as “an objective medical evaluation conducted by an independent, qualified medical specialist at BWC’s request for the purpose of clarifying an injured worker’s medical and disability status.” Essentially, injured workers must be examined by a doctor who will offer an opinion regarding both the degree of the injury and the employee’s ability to return to work. Payment of benefits will depend on the determination of this exam. In Ohio, the typical exams are:
- 90-day exam - An exam is required when a worker has received temporary total disability for 90 consecutive days to evaluate the employee’s current medical situation, a plan to move forward, barriers to returning to work, and more.
- 200-week exam - Another exam similar to the 90-day exam is required after an injured worker has received temporary total disability for 200 consecutive weeks to reevaluate the employee’s full medical and work circumstances.
- C-92 exam - This type of exam aims to provide insight into the degree of impairment for those who suffer a permanent disability. Here, a provider will determine a percentage equal to the individual’s impairment level.
Additionally, an injured worker can request an IME if there is a change in their status, or if they feel they are not being compensated appropriately. It is also possible to dispute the results of an IME and request a second opinion if workers’ believe the initial exam was not performed as it should have been.
Why Are Workers’ Comp Defense Medical Exams Important?
These IMEs, or defense medical exams, can be critical to an injured employee’s ability to obtain the maximum amount of compensation. Insurance companies and the BWC will use the exams to both qualify and disqualify workers, as well as determine how much compensation will be awarded. This is especially important for those receiving:
For workers with permanent injuries, the defense medical exams, as noted before, will result in a percentage of the permanent partial award. This means that the percentage of impairment as determined by the doctor will be equal to the compensation awarded. For example, if a worker injures his arm, he may visit a doctor for an IME. At the exam, the doctor determines that he has lost 65 percent use of that arm. The state has set compensation for loss of use of an arm at 225 weeks. In this example, the worker would receive payment for 65 percent of 225 weeks or about 146 weeks. This makes the impairment rating vital because even a slight change in the impairment rating could mean a significant increase or loss in compensation for the injured worker.
Preparing for Your Defense Medical Exam in Ohio
With so much riding on the outcome of your exam, it is important to be prepared. Here, we offer some helpful tips for a successful defense medical exam.
- Be truthful. If an injured worker is not honest about the details and scope of his injury, benefits could be denied.
- Be thorough. Discuss any symptoms you may be having with your medical provider. It is up to the professionals to determine what is relevant to your health and treatment. Even minor symptoms may provide information that is critical to your care.
- Have someone accompany you. A close friend or relative can take notes during the exam, recording the questions and opinions of the doctor, as well as your statements and concerns. If there is a dispute later, these notes can help keep your memory fresh, and that person can help lend credibility to your version of events.
- Avoid pain medication before the exam. Pain medication is intended to relieve pain and discomfort, and it is typically very effective in doing so. Taking the medication before an exam can make it appear as if you are in less pain than you may be. The doctor may not be able to determine the true extent of your injury if your exam is performed under the influence of medication.
Defense medical exams, or IMEs, can significantly impact the amount of compensation an injured worker and his family receives. These meetings are very important, and injured workers should take care to be prepared. At Monast Law Office, experienced workers’ compensation attorney Jim Monast and his team help injured Ohio workers and their families obtain all the compensation they deserve. If you have been hurt at work, take a moment to fill out the contact form on this page. You will receive a prompt response from a member of our team who can answer your questions and help you move forward most effectively.