EDD requesting independent medical exam for extended back injury SDI claim - should I be worried?

Had same thing happen to me last year!!! Don't worry too much, it's not necessarily about fraud. EDD just randomly checks some claims, especially ones that get extended beyond the initial period. The exam was actually pretty quick - like 15 mins. The doctor just asked me questions about my symptoms and did a brief physical exam. Make sure u bring ALL ur medical records though!!!

This is actually a standard procedure for extended SDI claims, particularly for conditions like back injuries that can have variable recovery timelines. EDD is required by law to periodically verify disability status on claims that extend beyond the initially projected recovery period. The independent medical examination (IME) is not necessarily an indication they suspect fraud - it's merely a verification step. When your doctor extends your claim, especially multiple times, it triggers a review process. The state wants their own medical professional to confirm the disability is continuing and that your treatment plan is appropriate. Bring all your documentation as planned - MRIs, treatment notes, and especially any surgical consultations are extremely helpful. Be honest about your limitations and pain levels. The examiner will likely perform some basic mobility tests and ask detailed questions about your treatment progress. One thing to prepare for: they may ask about your daily activities to assess functional limitations. Be straightforward about what you can and cannot do. If you need assistance with household tasks or personal care, mention that.

dont stress it man EDD does this all the time its like a random audit thing. my wife had back surgery last summer and they made her do this exam thing too. its mostly just to catch people who r claiming disability but actually out playing golf or whatever lol. as long as ur legit injured ur fine

They did this to me for my pregnancy disability when I needed to extend beyond the standard timeframe! I was SO nervous because I had complications and needed to stay on disability longer than initially expected. The exam was surprisingly thorough but respectful. Doctor reviewed all my records and asked detailed questions about my symptoms. Just be honest about your pain levels and how your condition affects your daily life. Don't try to "tough it out" during the exam - be truthful about your limitations. The doctor will probably do some physical assessments to check your mobility and pain responses. I continued receiving benefits after the exam with no interruption. Just make sure you don't miss the appointment - that can cause your benefits to stop immediately!

THEY'RE ABSOLUTELY LOOKING FOR FRAUD!!!! EDD is cracking down BIG TIME after all the pandemic fraud. They're trying to catch people and kick them off benefits. My cousin works at a doctor's office and says they're sending TONS of people for these "examinations" now. Be extremely careful what you say!!! They'll twist your words and if you mention ANY improvement they'll use it against you!

Having gone through two of these exams myself for a long-term neck injury, I can offer some practical advice: 1. Organize your medical records chronologically before the appointment. Tab or highlight important findings, especially from MRIs or specialist consultations. 2. Keep a pain/activity journal for the week before your exam. Note pain levels, activities you couldn't complete, medications taken, and side effects. Bring this with you. 3. Don't downplay OR exaggerate your symptoms. The doctors doing these exams have seen thousands of patients and can usually spot inconsistencies. 4. Answer questions directly but completely. If they ask "Can you lift objects?" don't just say "No" - explain "I can lift lightweight objects briefly, but anything over 5 pounds causes immediate sharp pain and anything over 10 pounds is impossible currently." 5. If you're having a better pain day during the exam, be clear about that - "Today is actually better than most days, but even now I'm at a 6/10 pain level with the medication working." After my exams, I continued receiving benefits without interruption. The decision usually came within 5-7 business days.

Calling EDD directly to ask about why you were selected for an exam might help ease your mind. They can sometimes explain the selection process and give you more information about what to expect. Getting through to an actual person at EDD is nearly impossible though - I spent THREE WEEKS trying to get answers about my own claim extension. I finally used Claimyr (claimyr.com) to get through to an EDD agent. They have a service that gets you connected to an actual EDD representative, usually within an hour. Saved me so much frustration! You can see how it works in their video demo: https://youtu.be/1X-mEsLtbmQ?si=1hcSq3KFtCr4oAmd When I finally spoke with an agent, they explained my exam was just part of random verification for extended claims and gave me detailed information about what documents would be most helpful to bring. Definitely worth getting those specific answers directly from EDD before your appointment.

btw i forgot to mention make sure u answer all their questions about daily activities HONESTLY! they asked me stuff like "can u do laundry" and "can u drive" and if u say no but they somehow find out u can, thats where the fraud accusations come in. my neighbor got caught lying about her capabilities and they made her pay back ALL her benefits!!!!!

After your examination, EDD typically takes 7-10 business days to process the medical examiner's findings and make a determination about continuing benefits. During this time, your current benefits should continue as normal. If the examiner confirms your disability, you'll simply receive your payments as usual with no interruption. If there are any discrepancies or if additional information is needed, you'll receive a notice explaining what's needed. In the rare case that the examiner doesn't agree with your treating physician's assessment, you would receive a formal notice of determination with appeal rights. This would explain the discrepancy and give you the opportunity to provide additional medical evidence or appeal the decision. As for whether the results are shared with your treating physician - typically no, not automatically. The EDD examiner makes an independent assessment. However, you can request a copy of the examination report for your records and share it with your doctor if needed.