The title of this article is misleading on purpose — because the question itself is the wrong question. The right question is not what to avoid saying. The right question is how to communicate with any physician in your workers’ compensation case so that the medical record accurately reflects your condition.
In a workers’ compensation case, you will interact with at least two types of physicians: your treating physician, who provides your medical care, and the Independent Medical Examination physician, who examines you at the insurance carrier’s request. The way you communicate with each one matters, but for different reasons. Your treating physician is documenting your condition in the medical record that will follow you through the entire case. The IME physician is evaluating your condition on behalf of the carrier. Both encounters require the same thing from you: honesty, accuracy, and specificity.
The fundamental rule: be honest, accurate, and specific
Tell the truth. Every time. To every physician. There is no shortcut around this. If you lie to a workers’ comp doctor — about how the injury happened, about your symptoms, about your medical history, about your ability to perform daily activities — and the lie is discovered, it can destroy your credibility and your case. The insurance carrier will use the inconsistency to argue that nothing you say is reliable.
Communicating injuries and limitations is important
Your treating physician is on your side in the sense that their job is to provide you with medical care and to document your condition accurately. The medical record your treating physician creates is the foundation of your workers’ compensation case. If the record is thorough and specific, it supports your claim. If it is vague, inconsistent, or incomplete, the carrier and the IME physician will exploit those gaps.
Tell your treating physician exactly what hurts, where it hurts, how much it hurts, when it hurts, and what makes it better or worse. Be specific. “My lower back hurts” is less useful than “I have a sharp pain in my lower left back that radiates down my left leg when I sit for more than twenty minutes or try to bend forward.” The more specific your description, the more specific the physician’s documentation, and the stronger your medical record.
Report every symptom, even ones that seem minor. If you have headaches along with your back pain, say so. If your sleep is disrupted by pain, say so. If you have difficulty with activities you used to do without thinking — climbing stairs, carrying groceries, getting in and out of a car — say so. These functional limitations are what the Board evaluates when determining your disability classification and your loss of earning capacity.
Disclose your complete medical history, including prior injuries and pre-existing conditions. If you had a prior back injury ten years ago that fully resolved, tell the physician. If you had knee surgery five years ago, tell the physician. The carrier will obtain your prior medical records. If the treating physician’s record does not mention a pre-existing condition that the carrier’s records show, it looks like you hid it — even if you simply forgot to mention it.
What to expect at the Independent Medical Examination
The IME is not your doctor’s appointment. The IME physician is selected and paid by the insurance carrier. The examination is designed to provide the carrier with a medical opinion about your condition. That opinion may agree with your treating physician’s findings or it may disagree. The stakes are real — the IME report can be used to reduce or discontinue your benefits.
Answer every question the IME physician asks. Answer truthfully. Describe your symptoms the same way you described them to your treating physician. If a movement causes pain during the examination, say so. If a movement does not cause pain, say that too. Consistency between what you report to your treating physician and what you report at the IME is critical. If the IME physician’s report says you told them something different from what appears in your treating physician’s record, the carrier will use the inconsistency against you.
Do not exaggerate your symptoms. Do not minimize them. If the physician asks you to perform a movement and you can do it, do it. If you cannot do it or it causes significant pain, say so clearly. The IME physician is assessing both your condition and your credibility.
Answer the questions you are asked. Do not discuss the legal aspects of your case, your attorney, your frustrations with the process, or your opinions about the insurance carrier. The IME is a medical examination. Keep it medical.
The mistakes that actually hurt cases
The most damaging mistake is inconsistency. If you tell your treating physician that you cannot lift more than ten pounds, and then the IME physician observes you lifting a twenty-pound bag without apparent difficulty, the inconsistency will appear in the IME report.
This does not mean you should never leave your house or live in fear of being observed. It means you should describe your condition to your physicians the way it actually is — including the good days and the bad days. Most pain conditions fluctuate. Having a good day where you can sit longer than usual does not mean you are faking. But if your medical record never acknowledges that fluctuation, the one good day captured on surveillance will look like a contradiction.
The second most damaging mistake is failing to disclose pre-existing conditions. The carrier will argue that your symptoms are from the old injury, not the new one. If your treating physician’s record shows you disclosed the prior condition and the physician distinguished the current injury from the prior one, that argument fails. If the prior condition was never mentioned, the carrier’s argument gains traction.
The third mistake is discussing the case in non-medical terms. Telling the IME physician “my lawyer says I should get permanent disability” or “the insurance company is trying to screw me” introduces non-medical information into a medical examination. It does not help your case. It gives the IME physician a reason to question your motives.
Your rights at the IME
You have the right to bring a companion to the IME. You have the right to videotape the examination. The IME physician cannot refuse to conduct the examination because you are recording it. A video record documents exactly what happened — what questions were asked, what tests were performed, and how long the examination lasted. If the IME report later describes an examination that differs from what actually occurred, the video is your evidence.
You must attend the IME if it is properly scheduled with at least seven days’ advance notice. Missing an IME without a valid reason can result in suspension of your benefits.
How Schwartzapfel Holbrook helps clients
At Schwartzapfel Holbrook, we answer every question a client may have for both treating physician visits and IMEs. The medical record is the evidence your case is built on. What you say to every physician goes into that record. Accuracy, consistency, specificity, and honesty are not strategies. They are requirements.
Schwartzapfel Holbrook / Fighting For You