IME Exams in Wisconsin

Worker Compensation

Mays Law Office, LLC. is here to protect you from the intimidation of the so-called “IME/Independent Medical Examination” allowed in Wisconsin.

A Wisconsin injured worker files for workers compensation benefits with their employer’s workers compensation insurance carrier and before paying benefits, the insurance company demands that the injured worker see an “independent medical examiner.” 

What is this and what should the injured worker expect?

To be clear, in Wisconsin, these appointments are completely selected and scheduled by the workers compensation carrier, and not the injured worker.  They are far from being  “independent” or impartial.  In fact, a better description, would be to call them an “adverse medical examination” because there is NO medical treatment rendered and the medical report is created solely for the workers compensation carrier with a desired outcome to deny workers compensation benefits.  Ultimately, the insurance carrier is hoping for a medical opinion from their examiner that gives a medical basis and opinion that will allow them to deny the injured worker benefits.     

In Wisconsin, an adverse medical examination can only take place with a physician, chiropractor, psychologist, dentists, podiatrist, physician assistant, or an advanced nurse practitioner.  It is the workers compensation insurance carrier that gets to choose who the injured worker will see for a medical examination.  The location of such an examination can be no further than 100 miles of the injured workers primary residence as the crow flies.  The time and date should be discussed before the examination is scheduled in the event the injured worker has a scheduling conflict.  However, this respectful communication with the injured worker is rarely communicated and instead a date and time is given.   The insurance company is required to provide, in advance of the examination, prepaid roundtrip mileage.  Not providing such advanced payment ahead of time can give the injured worker a basis to not appear.  Also, reimbursable to the injured work, prior to the examination, is anticipated wage loss, meals, and lodging, if applicable.  Information regarding the adverse medical examination must be provided to the injured worker in advance and in writing.  The notification must provide clearly the following information:

  • Date, time and location of the appointment;
  • Details for changing such date, time, and location, should a conflict exist;
  • The injured workers right to have their own physician, chiropractor, dentist, and so on, present at such appointment;
  • The right to receive the adverse medical examiner’s report(s) once completed and received by the insurance company or employer;
  • The injured worker’s right to have a translator present at the exam if a language barrier exists.

Generally, the workers compensation insurance carrier provides the medical examiner with the injured workers medical information and records prior to the examination, but often the examiner never reviews or looks at the information before the examination.  In fact, during the medical examination, the medical examiner very often seems to know little to nothing about the injured worker’s medical condition, diagnosis, prognosis and will rely on the injured worker to fill him in on his medical history and details of the work injury and subsequent medical treatment.  Obviously, this is infuriating for the injured worker who has been compelled to go to this examination with a doctor, who at the time of the appointment, appears ignorant to the injured worker’s medical condition.

In preparing to meet with the adverse medical examiner, the Wisconsin injured worker should:

*Dress casually with an eye toward removing their shirt or pants in the event the examiner wants to do a limited examination of their body.  Wearing a pair of athletic shorts, athletic top/bra can prevent the injured worker from being instructed to disrobe.  In almost every situation, an injured worker should never be naked during these examinations;

*Do not take any pain medication ahead of the examination.  This way the examiner sees the injured worker in their purest form, without medication to mask the pain.  So, for example, if it hurts to raise your arm because of a shoulder injury occurring at work then the examiner should see such pain exhibited.

*Respond only to the examiner’s questions and never be too talkative.  The more the injured worker speaks and tells the examiner, the more such information will be misconstrued, taken out-of-context, and used against the injured worker.

*Take pictures of the examination room if it is dirty or unprofessional appearing.  Keep a journal/notes/recordings of anything unusual.  Such information can be used to discredit the adverse examiner’s credibility/opinions.  Mays Law Office had a client that was put into a dirty examination room and asked to sit on an examination table that was soiled/wet from the last patient!  A picture was taken and used against the insurance company for relying on an unprofessional physician to support their denial of benefits.

*Be consistent in your behavior and movements with your injury and physical restrictions.  So, for instance, if you have a low back injury and you have a restriction of no bending, then do not be seen bending over to remove your shoes for the examination.  Or, if you require a cane for mobility then make sure you have and use your cane at the examination.

In sum, the Wisconsin injured worker needs to keep in mind that they are being watched from the moment they enter and leave the examiner’s parking lot as the examiner and/or his staff are hoping to see and document anything that puts the truthfulness of the work injury in question.  So, if the injured worker is prohibited from climbing stairs due to their knee injury, then use the elevator, and not the stairs, to reach the examiner’s second floor office.  

Attorney Lisa Pierobon Mays is proud to have been involved in changing Wisconsin law in favor of protecting injured workers during adverse medical examinations.

In the past, Wisconsin law allowed the medical examiner to meet with the injured worker, male or female, alone and without any observation from a witness, such as a spouse, parent, other family member, or even a friend.  This policy was obviously problematic, especially where it was a male doctor examining female injured workers.  Often, these adverse medical examinations require a certain level of disrobing and a hands-on physical exam of the injured worker.  Such a situation is intimidating, and downright creepy, where a trusted doctor-patient has NOT been selected or even established. 

Attorney Pierobon Mays initiated awareness with the Wisconsin Worker’s Compensation Advisory Council pushing for a change to be made in the workers compensation legislation.  The Council on December 13. 2021 approved such a change and the agreed upon bill will now allow observers present, chosen by the employee, during such examination.  The Agreed Upon bill is expected to pass the Wisconsin legislature.                        

Lastly, the best course of action for the Wisconsin injured worker who is asked to submit to an “independent medical examination” coordinated by the workers compensation insurance carrier is to call Attorney Lisa Pierobon Mays at (608)257-0440 so that she can remind you of these Do’s and Don’t’s and get you properly prepared.  Initial consultations are always free.  

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