IME (Impartial Medical Exam) or Referee Examinations

This is a continuation of last month’s article providing information explaining what SECOPS and IMEs are and how injured letter carriers and their physicians should approach them. The September 2017 addition of the LIMB Leader last month discussed Second Opinion Examinations (SECOPS) ordered by OWCP and should be referred to when such an examination is ordered by OWCP. This month’s article discusses the information explaining the IMEs or (Referee examination) that may be ordered by OWCP.

OWCP may select a third physician to conduct an IME when the medical report of the injured worker’s attending physician, and the medical report of either a SECOP or an OWCP medical adviser, have equal weight and rationale but reach opposing conclusions. This is also called a referee examination.

The physician selected for the IME should be qualified in the appropriate specialty and have no prior connection to the case. If the opinion of the referee physician is sufficiently well rationalized and based on a proper factual background, OWCP must give it special weight. Because of the special weight given to the IME, OWCP has specific procedures in place that require it to select referee specialists on a strict rotating basis.

ECAB (the Employees’ Compensation Appeals Board) has placed great importance on the appearance as well as the fact of impartiality. ECAB has held that the Office (OWCP) has an obligation to verify that it has selected the impartial medical specialist in a fair and unbiased manner and that it maintains records for this very purpose. ECAB has recently set aside decisions where OWCP did not adequately document how it selected the referee physicians for the IMEs.

As was the case with SECOPs, an injured employee cannot opt out of an IME. A refusal to participate in the IME could result in the suspension of compensation unless the employee establishes good cause for their failure to attend.

The employee also has certain rights associated with the IME. Unlike the SECOP, the claimant does not have a right to have his or her physician present for the IME. The claimant, however, can participate in the selection of the impartial medical examiner under certain circumstances. Examples of these circumstances are:

• When the claimant specifically requests to participate and provides a valid reason;

• When the claimant has a valid objection to the physician selected by OWCP to conduct the IME.

The Federal Employee Compensation Act (FECA) Procedure Manual lists some possible valid reasons for participating in or objecting to the selection process including:

• Documented bias or unprofessional behavior by the select physician;

• A claimant with a medically documented inability to travel to the arranged appointment when an appropriate specialist may be located closer.

If OWCP finds that the claimant’s reason to participate in the selection process is acceptable, it will prepare a list of three available specialists, including a candidate from a minority group if indicated, and ask the claimant to choose one. This is the extent that OWCP allows the claimant to intervene in the process.

Next month’s article will begin to examine the Statement of Accepted Facts that will be developed by a Claims Examiner that they feel is relevant for your claim and how they play an important factor when attending a SECOP or IME.

Be safe and keep smiling.