Independent Medical Examination in Workers Comp
The independent medical examination, almost always called the IME, is not as independent as the name suggests. It is a medical exam ordered by the workers comp insurance carrier and performed by a doctor the carrier selected and paid. The carrier has a statutory right to order an IME in most states, and the IME report often arrives at a critical point in the claim: just before a suspension of benefits, just before a denial of surgical authorization, or just before a settlement offer.
This page covers what an IME actually is, why the carrier is sending you to one, how the exam typically runs, and the things a worker can do before, during, and after the IME to protect the claim.
What an IME is and who pays for it
An IME is a one-time medical evaluation. The IME doctor reviews the worker’s medical records, conducts a physical examination, and writes a report that addresses specific questions the carrier asked. The most common IME questions:
- Is the injury related to the work incident?
- Has the worker reached maximum medical improvement?
- What is the permanent impairment rating?
- Is the recommended surgery medically necessary?
- What permanent work restrictions, if any, are appropriate?
- Has the worker fully cooperated with treatment?
The carrier pays the IME doctor’s fee. The fee is typically $1,500 to $5,000 depending on the complexity of the file and the specialty involved. The worker is generally entitled to be paid mileage and any lost wages for attending. In most states the worker is required to attend on penalty of suspension of benefits.
The “independent” label is technically accurate in that the IME doctor is not the worker’s treating physician and (in theory) has no prior relationship with either party. In practice, IME doctors who consistently produce reports favorable to insurance carriers tend to get more IME referrals. The economics of being an IME doctor incentivize a defense-leaning view of the case.
Why the IME is being ordered
A worker scheduled for an IME should think about timing. The carrier is rarely curious. The carrier is building or defending a position. Common IME triggers:
The case is approaching MMI. The carrier wants a second opinion on whether the treating doctor’s continued treatment is reasonable, or whether MMI should be declared so TTD can be cut off.
Surgery has been recommended. The carrier wants a second opinion on whether the recommended surgery is medically necessary and related to the work injury. An IME report that opines surgery is not necessary lets the carrier deny authorization.
A rating has been assigned. The carrier wants an independent rating to challenge the treating doctor’s number. A lower IME rating reduces the PPD award.
A return-to-work issue is pending. The carrier wants permanent restrictions documented so light-duty work or vocational rehab can be triggered.
Settlement is being discussed. A defensible IME report supports the carrier’s reserve number and the settlement offer that flows from it.
Surveillance has been reviewed. If video surveillance shows activities inconsistent with the worker’s reported limitations, the carrier may order an IME to bring the inconsistency to a medical opinion.
Knowing why the IME was scheduled helps the worker prepare. Ask your attorney (or the claims examiner if pro se) what specific questions the IME doctor will be addressing. That information is usually contained in the carrier’s referral letter.
What the exam typically looks like
The IME usually runs 30 to 90 minutes. A typical structure:
- Intake. Worker fills out a questionnaire about pain, function, medications, and history.
- Records review. The IME doctor has already reviewed the medical records before the appointment. The doctor will ask the worker to confirm or correct key facts.
- History of injury. The doctor asks the worker to describe how the injury happened, every body part affected, current symptoms, and current limitations. This is the most consequential part of the exam.
- Physical examination. Range of motion measurements, strength testing, sensation testing, gait analysis, observation of how the worker moves. The doctor is looking for both objective findings and inconsistencies between subjective complaints and observed function.
- Wrap-up. The doctor often does not share the opinion with the worker at the exam. The report is sent to the carrier first.
Several IME doctors use Waddell signs or other “validity” tests to flag inconsistencies. A worker who exaggerates symptoms during the exam can produce a report that undermines the entire case.
How to prepare for an IME
A worker scheduled for an IME has limited control but a few real preparation steps:
Tell the truth about everything. Including symptoms that fluctuate, including activities you can still do, including pre-existing conditions. The IME doctor has your records. Inconsistencies between what you say at the exam and what is in the chart are the easiest way to produce a damaging report.
Bring a written list of every body part that hurts. If your left shoulder hurts and your low back hurts and your right knee hurts, write all three down. An IME report can only address the parts of the body the worker actually mentions.
Bring a list of every medication you take, prescription and over-the-counter. Including the dose and how often.
Bring a list of every activity that is harder now than before the injury. Specific activities, with specific limits. “I cannot lift my arm above shoulder height to put dishes away” lands better than “my shoulder hurts.”
Do not exaggerate. The doctor is looking for exaggeration. Even small theatrical movements during gait or range of motion testing can produce a Waddell finding or a “symptom magnification” note in the report.
Do not minimize either. The exam is the snapshot. If you have a good day on exam day and you tell the doctor you feel fine, the report will say you feel fine.
Have a friend or family member observe if state law allows. Some states allow a third-party observer at the IME. Some carriers object. Check state law before bringing someone.
Do not arrive with painkillers loaded up. If you took your medication right before the exam to mask symptoms, the exam will show artificially good function and the report will say so.
After the report arrives
The IME report goes to the carrier first. The worker (or the worker’s attorney) usually receives a copy on request. Once the report is in hand, several moves are possible:
Match it against the treating doctor’s records. Inconsistencies between the IME and the treating doctor are the basis for any contest. Highlight every disagreement and show it to the treating doctor.
Get the treating doctor to write a responsive note. A short note from the treating doctor that addresses the IME points (and rebuts the IME conclusions) is the cleanest contemporary evidence in your file.
Consider a second IME. Most states allow the worker to obtain their own IME at the worker’s expense, with potential reimbursement if the rating moves in the worker’s favor.
Request an agreed medical examiner. If the state has an AME procedure, ask the carrier to jointly select a neutral examiner. AME opinions often carry more weight at hearing.
Take the IME doctor’s deposition. If the case is heading to a hearing, deposing the IME doctor can expose the IME’s methodology, the time spent on the exam, and any prior testimony in similar cases. IME doctors who do 500 IMEs a year tend to be vulnerable on cross.
Pushing back on an IME-driven suspension
If the carrier cites the IME as the basis for a suspension of benefits, the worker has a short window to challenge it. The challenge usually involves:
- Filing a motion or request for hearing to contest the suspension.
- Providing the treating doctor’s contrary opinion.
- Subpoenaing the IME doctor’s testimony for the hearing.
- Asking the commission to order benefits resumed pending hearing.
Time is the most important factor here. Most state statutes give the worker 30 days to challenge a suspension notice. After that, the suspension stands.
Penalties for refusing an IME
Refusing to attend an IME has consequences. Most states authorize the carrier to suspend benefits while the worker is non-cooperative. A worker who does not want to attend should not simply refuse. The right move is to seek a protective order from the commission addressing the specific concern (e.g., excessive travel distance, repeated IMEs on the same issue, scheduling outside reasonable hours).
Some states require the IME to be within a reasonable distance from the worker’s residence. If the carrier schedules an IME 200 miles away when a qualified IME doctor exists 20 miles away, ask the commission to require local scheduling.
Related
- MMI in workers comp for the maximum medical improvement determination the IME often addresses.
- When to hire a workers comp lawyer for the moment an IME is scheduled.
- Permanent partial disability for the rating dispute downstream of the IME.
- Does surgery increase workers comp settlement for the role IMEs play in contesting surgical authorization.