If you’ve been injured at work in Ohio, you will have to attend an Independent Medical Examination (DME), often more than once. The examining doctor’s report can impact your compensation, medical treatment approvals, and ability to continue receiving benefits, so understanding what these exams are and how to prepare is key to protecting your interests.
An IME is exactly what it sounds like – a medical evaluation by a doctor who hasn’t been treating you. The Ohio Bureau of Workers’ Compensation (BWC), your employer, or in some cases, the Ohio Industrial Commission, may request this exam to get an independent opinion about your on-the-job injury, your ability to work, and your ongoing medical needs. In this guide, we’ll explain what an IME is, when they’re required, and how a workers’ compensation lawyer can help.
What Is a Defense Medical Exam?
The Ohio BWC defines a DME as “an objective medical evaluation conducted by an independent, qualified medical specialist at BWC’s request for the purpose of clarifying an injured worker’s medical and disability status.” In simpler terms, it’s an exam by a doctor (selected by the BWC or your employer) who will evaluate your condition and write a medical report.
This definition sounds neutral, but it’s important to note that these doctors often have ongoing relationships with the organizations that hire them. Most of these physicians receive a significant portion of their annual income doing these Defense Medical Exams for the Ohio BWC, employers, and insurance companies; relatively few spend much of their professional time actually treating injured people.
This doctor’s job is to assess how severe your injury is, check if you can return to work, and determine if your condition relates to your workplace accident. Their report can help determine whether you continue receiving workers’ compensation benefits, how much you get paid, and what medical treatment gets approved.
The BWC or your employer can request a DME at any time during your workers’ comp claim. The timing often depends on how much your benefits are costing them and whether they want to challenge your own doctor’s treatment recommendations. Additional DMEs can happen when disputes arise about your condition, future treatment needs, or ability to work.
When IMEs Are Required in Ohio
Ohio law mandates certain DMEs based on how long you’ve been receiving benefits. These mandatory examinations serve as checkpoints in the workers’ compensation system, allowing the BWC to reassess your condition and work capacity at key intervals. The law sets these timeframes to ensure that workers aren’t receiving benefits longer than necessary while still protecting those who need continued support.
- 90-Day Examinations: If you’ve been on temporary total disability for 90 consecutive days, the BWC must schedule a DME. This exam evaluates your medical situation, identifies barriers to returning to work, and explores solutions for getting you back to employment. The examiner will assess if the treatment you’ve received has been effective and if there are alternative approaches that might help you recover faster.
- 200-Week Examinations: After you’ve received temporary total disability for 200 consecutive weeks (about four years), another DME is required. This exam takes a detailed look at your medical status and work prospects, recognizing that your condition may have stabilized by this point. The doctor will evaluate whether you’ve reached maximum medical improvement and assess your potential for any type of employment.
Beyond these mandatory exams, the BWC or your employer can request additional DMEs whenever disputes arise about your condition, treatment needs, or ability to work. They might request a DME if your treating doctor recommends expensive procedures or if they suspect you’re capable of working. These additional DMEs can happen at any time and often catch injured workers off guard, making preparation even more important.
Your Rights During a DME
Your rights during a DME depend on who requested the physical examination. It’s important to be aware that this exam is not an opportunity to support your case; defense physicians are usually looking for a reason to deny your claim. While it’s important to be honest, you should not volunteer information.
BWC or MCO-Requested DMEs
You can bring a family member or friend to observe the examination. Having a witness present can provide emotional support and help you remember what happened during the exam. Legal representatives, union reps, employers, or their agents can’t attend these examinations, as the BWC’s Disability Evaluation Panel Handbook states: “During a medical examination requested by BWC or the MCO, the injured worker may choose to have a family member or friend present.” There is no provision for any other witness.
Employer-Requested DMEs
The Ohio Administrative Code allows you to have a relative present during these examinations. (Legal representatives are still not permitted at employer-requested DMEs.) The code states: “Representatives of the parties may not be present at the medical examination… Injured workers may have a relative present at such medical examinations if the injured worker desires to have a relative present.”
Important: No Doctor-Patient Privilege
Everything you say during a DME can be used against you at hearings. The doctor will document not just what you tell them, but also what they observe about your behavior, movement, and apparent pain levels. If they see you walking normally to the building but limping inside, that discrepancy will appear in their report and could hurt your credibility.
How to Prepare for Your DME
Preparation can make an important difference in your DME experience and its outcome. Taking time to organize your information and practice describing your symptoms can help you present your case clearly and consistently.
- Remember that this doctor works for the BWC or your employer, not for you, and they will be looking for evidence to deny your claim.
- Review the timeline of events from your workplace accident to the present day.
- Practice describing your injury and symptoms consistently, using the same terms you’ve used with your doctors.
- Be ready to explain how your condition affects your daily life and work, including tasks you can no longer perform.
What Happens During the Examination?
DMEs typically follow a standard format, though the details vary based on your injury type and the doctor’s own approach.
In most cases, the doctor will start by asking about your injury, medical history, symptoms, and how your condition affects your life. They’ll want details about the accident, including exactly how it happened and what you felt immediately afterward. You’ll discuss your treatment history, what helps your symptoms, and what makes them worse.
The physical exam varies based on your injury type. For back injuries, expect tests of range of motion, flexibility, strength, and neurological function. For shoulder problems, they may check your ability to lift, reach, and rotate your arm in different directions.
The doctor will look for consistency between your reported symptoms and what they observe during the examination. They’ll evaluate if your symptoms match the expected pattern for your type of injury and the medical evidence in your file.
Potential DME Outcomes and Their Impact
The DME report can lead to several different outcomes, each with different implications for your benefits and medical care.
- Maximum Medical Improvement (MMI): If the DME doctor determines you’ve reached MMI, your temporary disability benefits may end. This doesn’t mean you’re fully healed – it means further treatment won’t greatly improve your condition. This finding can trigger a transition from temporary to permanent benefits.
- Return-to-Work Determinations: The doctor may conclude you can return to work, either with or without restrictions. This finding could trigger a change from total disability to partial disability benefits, or end your workers’ compensation benefits entirely if they believe you can return to your pre-injury job. The doctor will specify any work restrictions they recommend, such as lifting limits or movement restrictions.
- Treatment Recommendations: The DME doctor might agree with your treatment plan, or they may recommend different care. Their opinion carries major weight in BWC decisions about your future medical treatment. If the DME doctor disagrees with your treating physician’s recommendations, the BWC may deny coverage for certain procedures or medications.
For permanent injuries, the DME helps determine your permanent disability rating, which considers both your medical impairment and how it affects your ability to work. If you disagree with this rating, you can get another medical opinion at your own expense and request a hearing to challenge the finding.
Protecting Yourself During and After a DME
Your behavior during the examination and your response to the report afterward both influence how your claim proceeds. Being proactive gives you the best chance of maintaining your benefits and getting appropriate medical care.
- During the Exam: Describe your symptoms without minimizing their impact, and stay consistent with previous medical records and statements you’ve made to other doctors. Document everything that happens during the examination, including the doctor’s questions, your responses, and any tests performed.
- After the Exam: You should receive a copy of the DME report within a few weeks of the examination. Review it carefully for inaccuracies, such as incorrect information about your injury history, symptoms, or physical findings. Note any important details the doctor missed or misrepresented in their report.
If you disagree with the findings, you can challenge them through the workers’ compensation system. Working with an experienced attorney also improves your chances of successfully challenging an unfavorable DME report.
How Working with a Workers’ Compensation Attorney Can Help
Having legal representation for your workers’ compensation claim from the outset provides important advantages. An attorney can help you prepare for the examination by reviewing your medical records, identifying potential weak points, and practicing how to describe your symptoms clearly. They may know the reputation of certain DME doctors and can advise you on what to expect. Your workers’ compensation lawyer might also recommend getting your own medical evaluation before the DME to establish a strong foundation for your case.
After the DME, your attorney will review the report for accuracy and identify any discrepancies between the findings and your actual condition. They know how to challenge improper findings through the appropriate channels. Working with an experienced workers’ compensation lawyer from the beginning gives you the best chance of maintaining access to the wage loss benefits and medical treatment you need.
Need Help with Your Workers’ Compensation DME?
If you have a workers’ compensation claim, or you’re facing an upcoming Defense Medical Exam for an existing claim, or you need assistance challenging unfavorable DME results, the experienced attorneys at Plevin & Gallucci are here to help. We’ll review your case, help you prepare for your DME, and fight to ensure you receive the benefits you’re entitled to. With over 40 years of experience in Ohio workers’ compensation law, our legal team knows how to protect your rights during and after your DME. To schedule an initial consultation, call 855-4PLEVIN, fill out our contact form, or click in the bottom right-hand corner of the page to chat with an agent now.
