Overview: The law allows your employer or its worker’s compensation insurance carrier to schedule a reasonable medical evaluation by a doctor of its choosing, and you are required to attend. Sec. 102.13(1) Wis. Stats.
The defense calls these evaluations “independent medical evaluations,” but there is nothing independent about them because the doctors who perform these evaluations are selected by, and handsomely paid by, your employer or its carrier. Therefore, we call them “defense medical evaluations” or “adverse medical evaluations.” The defense tends to use the same doctors over and over again.
Generally, defense examinations are scheduled with orthopedic surgeons, neurologists and neurological surgeons, but sometimes they are scheduled with chiropractors and very occasionally they may be scheduled with psychologists, podiatrists, physician assistants, advanced nurse practitioners or dentists. The nature of the work injury usually dictates this choice.
Am I required to attend? Almost always the answer is yes – see Warning, below. However, the carrier must follow the requirements of the law in setting up the appointment: It must notify you in writing of the date, time and place of the examination and of the name and practice specialization of the doctor doing the examination. It must also tell you how to change the date if you cannot attend the examination as scheduled. You need to have a good reason to object. A conflicting appointment with your own physician or for tests ordered by your doctor is an appropriate reason to request a new date and time. Your preference just to put the defense exam off is not a good reason.
And before the examination, the worker’s compensation carrier must send you a check for reimbursement of your round-trip mileage (at the reimbursement rate in effect at the time of the appointment, currently 51 cents per mile). Also, if you lose time from work, the carrier must pay your lost wages. Lost wages means your actual lost wages, not payment of your lost time at the temporary disability rate.
The carrier can schedule an examination up to 100 miles from your home, but that distance is calculated “as the crow flies” and not as the roads go. This means the carrier can require you to travel a bit further than 100 miles, one way, for the appointment.
Warning: As long as the carrier properly schedules a reasonable examination with a doctor of its choosing, you must attend, and if you fail to attend, the carrier can stop your worker’s compensation benefits until you do.
Before you go: If the worker’s compensation carrier has set up such an appointment, we highly recommend that you contact us to discuss your case before you attend the appointment to be sure you are, in fact, required to attend. Sometimes the carrier sets up an examination that is not “reasonable.” What is reasonable depends on the type of injury and the type of treatment you have had.
It is in your interest to understand what goes on at a defense evaluation before you attend. It is also important that you know what you are and are not obligated to do. For example, you are not obligated to collect your x-ray films from your clinics and bring them to the defense medical examiner even though the carrier’s letter notifying you of the appointment asks you to do this.
Again we recommend that you contact us to discuss all of this further before you attend any defense medical examination.