What to do When You Lose Benefits Based on an "Independent Medical Examination"

Our office receives many inquiries each year from CRPS sufferers who have had their benefits terminated following "Independent Medical Examinations" (IME's)

IME's are customarily requested by insurance companies in a variety of circumstances including claims for worker's compensation, long term disability and personal injury arising from auto accidents, fall downs, dog bites, etc.

Although these medical exams are performed by so-called "independent" doctors, many times these physicians are anything but independent. Often they are biased in favor of insurance companies who pay these doctors a lot of money for conducting the exams and for preparing written reports. Many doctors love getting this IME business from insurers and it doesn't take a brain surgeon to understand that a doctor who consistently sides with an CRPS sufferer is not likely to continue getting this business for long.

Sometimes the IME's are conducted by doctors who, although unbiased, simply don't have any experience or real understanding of CRPS. As most CRPS patients know all too well; not all doctors-not even all orthopedists or neurologists-specialize in this dreaded condition. Many simply misunderstand the disease, misdiagnose it, or worst of all, believe that it's "all in the patient's head".

What do you do then when one of these doctors conducts an IME and renders a report that results in a termination of your benefits?

The short answer is that you need to get legal advice immediately. In fact, it is best to obtain legal advice when you are first injured and long before you are sent for an IME. Depending on the circumstances and facts of your particular claim, an attorney may be able to request or demand that the IME be conducted by a specialist in CRPS. Such a specialist is much more likely to recognize and confirm your diagnosis than someone who has never treated the condition before. Another thing that is important is to make sure that the doctor conducting the IME is provided with all reports from your treating CRPS doctors.

Aside from giving an opinion that you do not suffer from CRPS, doctors who perform IME's may conclude that you are not entitled to benefits for a variety of other reasons. Sometimes, they will say that your condition is not serious; or not permanent; or that it is not related to your claimed accident. Each of these opinions may be contested or appealed or disputed by an attorney depending on your individual circumstances.

Since each claim is different and each State often has different laws, I encourage you all to talk to a lawyer in your own state immediately if your CPRS resulted from an accident at work or from someone else's negligence. The sooner you speak to an attorney after your accident, the faster you will know your rights and the easier it will be to help you.

Ronald P. Goldfaden
Certified by the Supreme Court of New Jersey as a Civil Trial Attorney
One Main Street
Chatham, NJ 07928
Email: RGOLDFAD@NJATTY.COM