What is a "reasonable time and place for a physical examination" in regards to the workers comp act section 314 for IMEs?

Asked 5 months ago - Friedens, PA

The past 20 yrs the WC IME drs have reported that my injuries are totally disabling permanent and progressive, adding that my injuries will just continue to worsen. There are plenty of drs in every specialty who do IMEs that are within an hr from me one way but the state WC fund began setting up IMEs that are 3+ hrs away, one way, bc they don't like what their own IME drs continued to report and so sending me further & further away in attempts to find one who will help them instead of being truthful. I live in constant pain with multiple severe & progressive spine & nerve conditions that's been stated by my and all their drs to be all related work injuries. Can something be done to stop this complete waste of state tax $ and that's been causing me unwarranted suffering for so long?

Attorney answers (10)

  1. Robert Alan Huber

    Pro

    Contributor Level 13

    10

    Lawyers agree

    Answered . The issue of reasonableness as to the time and location of an IME is frequently argued. If there are a sufficient number of physicians who specialize in the field of medicine to examine you that are within an hour to hour and one-half from you, your attorney can make a pretty strong argument to the workers compensation judge that the exam should take place by a physician in your area (that area). However , in ore rural areas,I have had clients who had to travel nearly 4 hours one way for an IME. We handled that by having the judge order transportation for our client and he ordered that the carrier had to pay for our client's hotel stat for 1 night since our client could not tolerate driving for so long in 1 day you can argue to the WXJ that the Find is doctor shopping. Some judges will agree, others won't.
    Generally though, if the insurance carrier is wiling to foot the bill to sent you to a long distance IME - especially for a doctor who may specialize or sub specialize, most judges allow that exam to take place in my experience.
    If you have an attorney, you should direct these questions to him or her. If not , I strongly suggest you consult with an attorney who is certified as a specialist in workers compensation law.
    It sounds like you may eventually require home health aide services to assist you. An attorney can help you get that help as well.
    Good luck!

  2. Glenn Neiman

    Pro

    Contributor Level 13

    6

    Lawyers agree

    Answered . I agree with Robert. What is "reasonable" with regard to an IME depends on the facts of each case and what Judge is deciding. Unfortunately, as long as transportation is provided, most Judges will allow an IME to take place at a distance greater than I think is reasonable. I also agree with Robert that if you do not have an attorney, you should get one immediately. When an IME happens, your benefits may be in jeopardy.

  3. Gary Charles Martin

    Contributor Level 6

    2

    Lawyers agree

    Answered . The answer given by the previous attorney is spot on as they say. Just as an aside, I doubt that the insurance carrier is concerned about the tax dollars being wasted. Its concern is to not "waste" insurance company money!!!!!

  4. Karl P. Voigt IV

    Contributor Level 11

    2

    Lawyers agree

    Answered . Very little can be done to prevent the carrier from sending you to insurance medical examinations (IMEs). The Worker's Compensation Act is often read to allow the carrier to send you to two of these examinations a year. The insurance company will argue that there are not many doctors from which to choose in Somerset County, where you live. And, as has already been pointed out, the judges hearing your case have quite a bit of discretion to allow distant IMEs.

    Of course, you should be reimbursed for your travel mileage, or, even better, provided transportation by a service paid for by the insurer.

    What has not yet been mentioned is that the judges are generally pretty familiar with the doctors to whom the insurance company is sending you. Therefore, they know that these doctors are in essence "hired guns ". If your case ever winds up before a judge, I would hope that your doctors, after 20 years of treatment, are far more familiar with your case and therefore far better able to give persuasive opinions regarding your medical status. It is never too early to prepare yourself for this likely eventuality.

    Now is exactly the time to start lining up your cannons. Good luck!

    Karl is a certified workers' compensation specialist in Pennsylvania. The answer to this question is based on... more
  5. Geoffrey Hillsberg

    Pro

    Contributor Level 12

    2

    Lawyers agree

    Answered . This seems like a long way to travel for an IME, but each case is evaluated on its own facts. If you do not have an attorney, you should consult with on immediately. You may be able to force the carrier to pick a doctor who is closer to where you live.

  6. Thomas James Pivnicny

    Contributor Level 10

    Answered . I concur with the previous answers posted by my colleagues.

    The above information posted by Thomas J. Pivnicny, Esquire is intended for general purposes and does not... more
  7. Christian Michael Petrucci

    Contributor Level 6

    Answered . I agree with the answers my colleagues have given. However, I would indicate that what is reasonable to one judge may not be to another. Reasonableness is subjective. If you think the IME's date time and place is unreasonable, then it might very well be. If you have an attorney you should discuss it immediately. If not, I would suggest retaining one before attending the IME.

    I am an attorney, but do not represent you. This communication is not intended as legal advice, and no attorney... more
  8. Christopher Scott Odhner

    Pro

    Contributor Level 5

    Answered . As has been previously mentioned, each case is evaluated differently based upon the specific facts of the case. If there are local doctors that are able to perform the IME, you will have a better chance of having the IME moved closer to you. You should certainly speak to an attorney, if you have not already. http://workerscomplawyerphiladelphia.com/

  9. James Bradley Mogul

    Contributor Level 9

    Answered . Reasonable time and place varies, but 3 hours is pretty far. You need a lawyer to step up for you to see if something can be done on your behalf, especially if there are closer doctors who can help you. Sorry you are going through this.

  10. Paula S. Robinson

    Pro

    Contributor Level 4

    Answered . So sorry to hear of your circumstance. If you are represented by an attorney, have them argue on your behalf and file the appropriate Petition, seeking review of your medical treatment so you can have your case heard by a workers' compensation judge. Although the Judges are all different, at least you would be able to state your case and try to get an appointment with an IME Dr. closer to your home. If you are not represented, you really owe it to yourself and your family to retain an attorney certified as a specialist in PA workers' comp . Also, agree that you may need in home health care, based on your description of your particular circumstance. Best of luck to you!

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