If you have a work-related injury or illness, always notify your employer and seek medical attention right away. In most cases, that means going to the ER first, or the nearest clinic. However, every state has its own workers’ compensation law that dictates how and when you can receive ongoing medical care. Once you file a workers’ compensation claim, you may need to attend an Independent Medical Examination (IME) at some point.
An independent medical exam means the insurance company wants a second opinion on your workers’ compensation case from a certified physician. More importantly, failing to appear for one as requested will likely put your workers’ comp benefits at risk.
Learn what to expect, how to prepare, things to avoid, and tips to help your own exam go smoothly below.
Independent Medical Examinations: Key Takeaways
- Only your employer or their insurance company can request an IME, and these exams will never cost you any money out of your own pocket.
- Generally, the purpose of a medical evaluation is to find evidence that helps the insurer legally deny you workers’ compensation.
- However, some states require one every 6 months for work-related injuries that require ongoing medical treatment.
- Failing to attend an IME as requested may cost you the right to claim any workers’ comp benefits.
- Never offer more info than the doctor asks for, and keep your answers short, direct, and factual.
- You may request copies of any IME exam test results or other documentation filed in your workers’ compensation case.
What is an Independent Medical Exam (IME)?
An Independent Medical Examination is an evaluation from a doctor who has no history with either you or your case. In other words, it will not be the treating doctor you normally see for your workers’ compensation injury. For workers’ compensation purposes, your employer’s insurance company chooses the doctor you see and pays for the medical evaluation.
Licensed doctors, psychologists, or other healthcare professionals in any discipline can perform Independent Medical Evaluations. Because insurance companies and employers request IMEs, their general purpose is to disprove your claim for workers’ compensation benefits. Any licensed physician who can help your claims examiner achieve that goal can conduct an Independent Medical Examination.
One of the most important things to remember is that your IME exam doctor is not on your side. They will look for clues that may indicate you are lying, exaggerating, or trying to defraud your employer’s insurance provider. Their goal is to report any information that can help the insurance company legally deny workers’ compensation claims.
Another important thing to remember: There is no doctor/patient confidentiality during the IME process. In other words, the doctor can relay anything you share at your exam with your workers’ comp claims adjuster. In addition, the professional who evaluates you will report on more than just your test results. They might look for discrepancies in how you move and act in the waiting room or parking lot, for example.
Understanding the Workers’ Comp IME Process
Most often, whoever requests it will want to time the Independent Medical Examination just right. When it happens soon after your work-related injury, the IME doctor might determine you need more treatment to recover.
That timing is balanced with the understanding that IME exam results are not always in the insurance company’s favor. Many times, an IME doctor determines that you do, in fact, have a work-related injury and deserve workers’ compensation benefits. When this happens, it costs the company that requested it some money and confirms your workers’ comp claim is accurate.
Remember, disputed issues on claims can also include things like incorrect information, or missing documentation the insurance company needs to finish processing your claim.
Important: You will never pay for an exam unless you or your attorney schedule one to dispute a previous IME’s findings.
An IME can happen any time after the insurance carrier requests it, and the timing often varies by state. These IME exams are more common with injuries takes longer to heal or improve, such as:
- Repetitive motion injuries that develop slowly over time, like carpal tunnel
- Musculoskeletal injuries, like chronic back pain from a herniated disc
- Catastrophic injuries, such as paralysis or brain damage from a head injury
Generally, the more expensive your treatment or longer you stay out of work drawing benefits, the more likely you are to receive an IME request. Since Independent Medical Examinations can cost more than $1,000, it makes more sense to request them for costly, long-term cases.
What Do IME Doctors Look For?
What an IME doctor looks for, of course, depends on each injured worker’s current condition. Each will likely review your medical history and check for obvious signs that you’re ready to go back to work. They might be keen to observe your physical reactions to the doctor’s touch, looking especially for:
- Expressions of pain on palpitation of the injured area
- Tenderness
- Swelling
- Any limitations on your usual range of motion
IME doctors will likely also look for other pre-existing conditions that may potentially exacerbate your work-related injuries. For example: They might pay extra attention to your weight or which hobbies you enjoy when examining your knee injury. IME doctors might ask if you enjoy spending time outdoors or play any sports with your grandkids. Hearing you talk about gardening or playing on the trampoline with your grandson might give them all the information they need to state your pain isn’t from a work injury in your IME report. Instead, the examining doctor can assert your knee pain comes from repeatedly kneeling and standing while weeding your own garden.
Are Independent Medical Examinations Required for Workers’ Comp?
In some states, yes, but not all. Since laws can change from year to year, it’s always best to check with your own state’s workers’ compensation office. You can find yours on the U.S. Department of Labor’s website here.
How an Unfavorable Report May Affect Your Medical Treatment and Benefits
Again, it depends on which state you live and work in. In certain states, it can make you lose your workers’ comp benefits entirely. But in others, you can sometimes request another exam. In Oregon, for example, you might be eligible for a Worker-Requested Medical Examination (WRME).
Pro Tip: If you’re worried about this happening to you, consult a workers’ comp lawyer in your state for free. Most workers’ compensation attorneys offer free initial consultations to people seeking out their services.
Tips to Make Independent Medical Exams Go Smoothly
It’s always a good idea to prepare for your IME. Here are some tips to help you do just that:
- Review your medical records
- Request to see all information sent to the examiner by your employer’s insurer
- Create a list of what you think the doctor should know – and keep it specific to your workplace injury and treatment
- Write down how your job injury or current symptoms affect you, your daily life, and your family, if applicable
- Dress professionally and comfortably
- Remember that someone may be observing you even before you walk in to see the doctor
- Be honest and polite
- Don’t exaggerate
- Keep conversation to a minimum; answer yes or no if possible, and keep answers focused only on their specific questions
- Remember, their goal is to report findings back to whomever requested your exam in order to deny you benefits
How to Get Expert Guidance on Workers’ Comp Claim Issues
A workers’ comp attorney in your state will know how to best protect your rights during independent medical exams. This can include things like securing expert testimony on your behalf that disputes the IME doctor’s opinion denying you benefits. You may have questions about specific tests, or whether you can bring someone with you into the exam room. An attorney can best advise you on what’s legal during an IME in your state.
Not sure how to find a workers’ compensation attorney who can review your case free of charge? We can connect you with someone who’s knowledgeable, local, and available to help you right away.
Lawyers that handle questions raised during independent medical examinations always work on contingency. That means if you don’t win your case, then you owe your attorney $0. But if you do win, then you only owe one small fee after you receive a settlement.
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Lisa Allen is a writer and editor who lives in suburban Kansas City. She holds MFAs in Creative Nonfiction and Poetry, both from the Solstice Low-Residency Program in Creative Writing at Pine Manor College. Prior to becoming a writer, Lisa worked as a paralegal, where she specialized in real estate in and around Chicago.
