EDD SDI claim confusion - doctor extended disability but IME says I'm cleared to work

This is a common issue with IMEs - they're paid by EDD to evaluate claims and often clear people to work sooner than treating physicians would recommend. When there's a conflict, EDD typically follows the IME's recommendation unless your doctor submits additional medical evidence showing why you still can't work. You should immediately have your doctor submit a new certification form (DE 2501) with detailed explanation of why you cannot return to work, including referencing those MRI results the IME didn't review. Call your doctor's office ASAP and make sure they understand the urgency.

this happened to my brother last year!! the EDD doctor said he could go back but his real doctor said no way. he ended up losing benefits for like 3 weeks while they fought about it but then got back pay when his doctor sent in more paperwork. total nightmare tho

I work in a medical office and we deal with this all the time. Here's what needs to happen: Your doctor needs to complete a supplemental medical certification explaining specifically WHY the IME assessment is incorrect. They should include: 1. Reference to objective findings (MRI results) 2. Specific functional limitations that prevent you from performing your job duties 3. Clear timeline for expected recovery with treatment plan Meanwhile, you should file an appeal right away if your benefits stop. You only have 20 days from the date of the determination to file an appeal. Don't wait for your doctor's new certification before appealing. Unfortunately, EDD often sides with their IMEs initially, so be prepared for a gap in payments. Document everything and keep following up.

I had the EXACT same thing happen to me in February!!!! The stupid IME said I was fine after a 10 minute appointment even though I could barely walk because of my herniated disc! I was SO MAD. My payments stopped for almost 4 weeks while we fought it. If you're going to call EDD, good luck actually reaching someone. I tried for DAYS and couldn't get through because of the "high call volume" BS they always use.

When this happened to me, I tried calling EDD disability for two weeks straight without ever getting through. I was about to give up when I found this service called Claimyr that got me connected to an EDD rep in about 20 minutes. It was worth every penny because I explained my situation directly to a claims examiner who put a note on my account and told me exactly what documentation they needed from my doctor. Saved me weeks of stress! You can check them out at claimyr.com - they even have a video showing how it works: https://youtu.be/1X-mEsLtbmQ?si=1hcSq3KFtCr4oAmd

Be careful here. IME reports often trigger fraud investigations if they contradict your treating physician by a significant margin. Make sure all your paperwork is completely accurate and consistent. EDD takes these IME reports very seriously since they've invested money in having them done. Your doctor needs to be very explicit about why construction work specifically is unsafe with your current condition.

call ur doctor right now and tell them to fax a appeal letter to EDD!! my friend had this happen and she lost benefits for like 6 weeks it was a mess dont wait!!!!!

After reading all these responses, here's what you should do, in order: 1. Have your doctor immediately submit a supplemental medical certification with detailed reasons why you cannot return to your specific job duties 2. File an appeal yourself using the DE 1000M form within 20 days of receiving the IME determination 3. Use Claimyr or keep calling EDD to speak with someone about your case 4. Document every communication with EDD and your doctor 5. Prepare financially for a potential gap in payments The good news is that if your appeal is successful, you'll receive back payments for any missed weeks. The bad news is it might take 4-6 weeks to resolve.

I went through this exact situation last year and it was incredibly stressful! The IME doctor spent maybe 20 minutes with me and didn't even review my recent test results either. What helped me was having my treating physician write a very detailed letter explaining not just that I couldn't work, but WHY - specifically mentioning the physical demands of my job that my injury prevented me from safely performing. They also referenced all the medical imaging and tests that the IME doctor didn't consider. It took about 5 weeks to get resolved, but I did eventually get all my back payments. The key is being very specific about your job requirements versus your medical limitations. Construction work has so many physical demands that an office job wouldn't have, so make sure your doctor addresses lifting, bending, standing for long periods, etc. Hang in there - it's frustrating but you can get through this!

I'm so sorry you're dealing with this - the stress of potentially losing benefits while you're still injured is awful. One thing I learned when I had a similar situation is that you should also request a copy of the IME report if you haven't already received it. Sometimes there are factual errors in the report (like incorrect information about your job duties or medical history) that you can point out in your appeal. Also, if your doctor prescribed any specific restrictions like "no lifting over 10 pounds" or "no prolonged standing," make sure those exact restrictions are clearly stated in the supplemental certification and that it explicitly says these restrictions are incompatible with construction work. The more specific and job-related the medical restrictions are, the stronger your case will be. EDD has to consider whether you can perform your specific job, not just any job in general.

I'm dealing with a similar situation right now and wanted to share what my disability attorney told me. When there's a conflict between your treating physician and an IME, EDD is required to consider both opinions, but they often give more weight to the IME initially since they paid for it. However, your treating physician's opinion should carry more weight because they have an ongoing relationship with you and complete knowledge of your medical history. The key is having your doctor submit a very thorough rebuttal that specifically addresses why the IME's conclusions are wrong. They should mention that the IME didn't review your latest MRI, explain how your specific injury affects your ability to do construction work, and provide a clear timeline for when you might actually be able to return. Also, don't be afraid to get a second opinion from another specialist if needed - sometimes having two doctors who agree can override one IME. The whole process is designed to be intimidating, but you have rights here. Stay persistent and document everything!

I'm going through something very similar right now and it's absolutely maddening! The IME doctor I saw spent literally 12 minutes with me, didn't ask about my job duties at all, and completely ignored the physical therapy notes showing I still have significant range of motion issues. Meanwhile my orthopedist who has been treating me for 4 months says I'm nowhere near ready to return to my warehouse job. What really gets me is that these IME doctors seem to have a quota or something - like they're incentivized to clear as many people as possible. I've heard from multiple people that the same IME doctors consistently clear everyone they see, regardless of the actual medical situation. It feels like such a rigged system. I'm currently waiting to hear back about my appeal, but reading everyone's experiences here at least makes me feel less alone in this mess. The financial stress while waiting for resolution is almost worse than the actual injury sometimes. Stay strong and keep fighting - it sounds like you're taking all the right steps!

I'm so sorry you're dealing with this - the whole IME system feels completely broken when doctors who barely know your case can override physicians who've been treating you for months. I went through something similar with a shoulder injury last year and the stress was unbelievable. One thing that really helped me was having my doctor include photos of my work site in the supplemental certification to show EDD exactly what my job entailed. Construction work is so physically demanding and variable - it's not like you can just "take it easy" when you're working with heavy materials, climbing scaffolding, or working in awkward positions all day. My treating physician took pictures during my appointment showing my limited range of motion and included those too. It made the case much more visual and concrete rather than just medical jargon. Also, if you have any coworkers who can write letters describing the physical demands of your specific job tasks, that can be powerful supporting evidence. The whole process took about 6 weeks for me but I did get all my back pay. Don't let them bully you into going back before you're truly ready - a re-injury could set you back months and put you in an even worse financial situation. You know your body better than some doctor who spent 15 minutes with you!