Workers' Compensation Update

Injured Workers Must Undergo Medical Exams

Employees who file workers' compensation claims must cooperate in medical examinations requested by their employers. Pennsylvania law entitles employers to send their injured employees for a "physical examination" or "expert interview" by health-care providers or other experts. Sometimes called "independent medical exams" or "IMEs," these examinations are often conducted by health-care providers or other experts who regularly contract with the insurance companies who are paying benefits to injured employees.

Employers and insurance carriers understandably want to know the precise status of an injured employee's condition. However, an injured employee often feels that the IME is not truly independent since the examiner is being paid by the insurance company. Some medical providers' sole source of income comes from conducting IMEs for workers' compensation insurance companies.

Recently, a nurse who suffered a shoulder injury refused to undergo further diagnostic testing as part of her employer-requested physical examination. The IME doctor concluded that the nurse was fabricating symptoms and he requested additional diagnostic testing to permit him to complete his evaluation. The nurse, who already had undergone two surgeries, MRI testing, and a bone scan, refused to undergo the additional MRI and bone scan requested by the IME physician.

The Pennsylvania Supreme Court ruled against her. The court found that the Workers' Compensation Act does not really define what a "physical examination" is, and that the medical community has generally defined it to mean a personal examination, not a diagnostic test. But the court also found that the availability of modern diagnostic testing cannot be ignored by the courts. The court decided that where an IME physician makes a reasonable request for a necessary test, an injured worker must cooperate or risk losing his or her benefits. Whether testing is reasonable or necessary is "inextricably related to the risk, intrusiveness and scope of the examination." Thus, a risky or painful diagnostic test may be one the employer may not demand.

While the court did not list what it considered to be reasonable and unreasonable procedures, it did identify X-rays as nonintrusive and observed that biopsies are considerably more intrusive. The court also noted that since injections are given in schools and in the workplace, an injection is not necessarily invasive. Likewise, blood testing, often performed in a physician's office by a technician, is neither invasive nor risky. The court found that an MRI and a bone scan are not intrusive or risky.

Physicians who regularly conduct medical examinations of injured workers for insurance carriers now know that they can request additional diagnostic testing as long as the testing is reasonable. Before challenging the obligation to cooperate, injured workers should seek legal advice and must appreciate that they may lose their entitlement to benefits if their refusal is not upheld in court.

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