What is an “independent medical examination” (IME)?

In the world of workers compensation insurance, an “independent medical exam” (or “IME”) refers to a third-party medical exam of an insurance claimant’s physical condition, with emphasis of course on the injury at issue. IMEs are usually not requested or issued until after at least one other doctor has opined on your (the claimant’s) condition, so the point of an IME is not the medical care itself, but rather the written report that comes out of it.

When IMEs are Needed

An independent medical exam is required whenever the insurer processing your claim states a need for one. If you received a letter in the mail attempting to schedule an independent medical exam, then you need to attend. If you received such a letter, it generally means that your employer’s workers’ comp insurance carrier is contesting some aspect of your claim. In some states, IMEs can be called up to three times (with up to three different health care providers). These are often called “panel exams.” However, either the employer or the employee can request an independent medical exam. You have to research the law of the state in which you are filing for workers compensation – sometimes, it may be advantageous for you as a claimant to take the reins here.

Role of the Doctor

The role of a doctor who acts as a medical examiner varies from state to state — even what that doctor is called varies. For instance, in California, the doctor is a “medical evaluator” and is generally mutually agreed upon by the parties. The doctor or medical evaluator exams the injured worker and takes a complete medical history. Some examiners may be more sympathetic to workers – some to employers. In some IMEs, you are also allowed to bring an unpaid observer with you if that makes you more comfortable, or if you want someone to serve (informally) as a witness to what occurs during the exam. Depending on the state, the observer may have to sign an “IME Observer Form” or a similar document. In no states, however, may the observer take part in the exam or interfere in any way with the exam. If s/he does interfere, you may have to redo the entire process!

Case Studies: Understanding Independent Medical Examinations (IMEs)

Case Study 1: Dispute Over Injury

John, an employee, filed a workers’ compensation claim after suffering an injury at work. The insurance company disputed the extent of John’s injury and requested an independent medical examination (IME). The IME doctor’s evaluation could have a significant impact on the outcome of John’s claim. John sought legal assistance to ensure his rights were protected during the IME process and to challenge any unfair assessment.

Case Study 2: Multiple IMEs

Sophia, another worker, had her workers’ compensation claim contested by her employer’s insurance carrier. The insurer requested multiple independent medical examinations (panel exams) with different healthcare providers. Sophia’s attorney advised her on the state’s laws regarding IMEs and helped her prepare for each examination. With legal guidance, Sophia navigated the IME process successfully, leading to a favorable resolution of her claim.

Case Study 3: Choosing the Right Doctor

Michael, a claimant, received a letter requesting an independent medical examination. Concerned about the objectivity of the IME doctor chosen by the insurance company, Michael sought legal counsel. His attorney provided insights into various workers’ comp doctors in the area and assisted Michael in choosing an unbiased and experienced medical evaluator for the examination. The attorney’s guidance proved crucial in strengthening Michael’s claim and obtaining fair compensation.

Getting Legal Help

If you have received a letter in the mail asking for an independent medical exam, then now may be a good time to get some help from a licensed workers’ compensation attorney in your jurisdiction. S/he will have helpful knowledge about various workers comp doctors in your area, and perhaps even who to choose or not to choose to evaluate your injury or illness. Understanding this part of the claims process is critical to having a successful workers comp claim.