How to Handle Your Workers' Compensation Independent Medical Examination
Learn tips for attending an independent medical examination in your workers' compensation case.
If you have filed a workers’ compensation claim, you may be asked to attend an independent medical examination. Independent medical exams (IME) are often requested when there is a dispute or question about what benefits you are entitled to. Because an IME can have a significant impact on the amount of benefits you may receive, you should be aware of the general purpose of the exam and how it can affect your case. Here are a few simple guidelines to help you prepare.
(For more information on filing a claim and what injuries may be covered, see our workers' compensation page.)
What Is an Independent Medical Examination?
An independent medical examination (IME) is an examination by a medical provider who may provide an expert opinion on your medical condition, your course of treatment, or the level of any disability that you currently have. After the exam, the doctor will issue a report answering questions about your condition, which may include one or more of the following, depending on the status of your claim:
- Has your condition been correctly diagnosed? For example, do you actually have the condition for which you have filed a claim?
- Did a workplace accident or exposure actually cause your condition? For example, is it possible that you developed this condition in a different manner, through your personal activities or other off-duty conduct?
- What is the extent of your impairment? The examiner will typically be asked to assign you an impairment rating, stated as a percentage of how much a certain body part, or your body as a whole, has been impaired as a result of your condition. This impairment rating will determine how much you will receive in permanent disability benefits. (See our article on permanent disability benefits for more information.)
- Do you need additional treatment or testing for your condition? Or have you reached maximum medical improvement and would not significantly benefit from further treatment? If you do need more treatment, what sort of treatment or testing is necessary and medically appropriate?
- Do you need work restrictions? And if so, what restrictions are appropriate? For example, are you able to lift more than 20 pounds?
- When will you be able to return to work (if at all)?
The IME doctor is most often hired by your employer (or its insurance company), when it disagrees with your course of treatment or disability rating. However, an IME may be ordered by your state’s workers’ compensation agency (often known as the Division of Workers’ Compensation or Bureau of Workers’ Compensation), or even by your own attorney to counter an IME requested by your employer or the state agency. You may have to attend multiple IMEs so that each side has a chance to have you examined by a medical provider of its choosing.
For an overview of independent medical exams, see What is an Independent Medical Examination and How Will It Affect My Workers' Compensation Case?
What Should You Do Before the Exam?
Be familiar with your medical history. The examiner will likely have all of your medical records related to your condition, including records of previous injuries to the same body part. The examiner will ask you about all of these things, so take a moment to review your medical history. Do not try to conceal any previous injuries or downplay them. However, you should point out how your injury or condition is different than it has been in the past.
Review how the accident happened. The examiner will ask you in detail about how the injury happened. Although workers’ compensation is a no-fault system, the examiner will want to make sure that the accident is in fact work-related. And, some examiners may be looking for inconsistencies in your story. Keep your answers brief, and make sure that they are consistent with what you have reported in the past (for example, in any accident reports or emergency room visits). Any changes in your story may be used as evidence that you are not telling the truth, so don’t be afraid to point out any inaccuracies in the reports.
Be familiar with your course of treatment. You will probably also be asked about your treatment history for this injury, so take the time to figure out what tests, surgeries, or other procedures or treatment you’ve received so far. This is not a memory test, so if you can’t remember a specific date or medication, that’s fine, but you should have a general knowledge about what medical treatment you have received and when.
Review your current symptoms. It is important to let the examiner know whether you are still experiencing pain, limitations, or other symptoms. Are you experiencing headaches or pain? Are you having difficulty with your everyday activities, such as walking, grooming, or sleeping? You will be asked in detail about your current symptoms and limitations, so make sure to include everything, no matter how minor it seems at the time.
Dress appropriately. Present yourself in a manner consistent with your injury. For example, if you have an ankle injury, you probably shouldn’t show up to the exam in high heels. Also, you should wear or bring any devices you need for your injury, such as crutches, dark sunglasses, or a sling. If you tell the doctor that you need to wear dark glasses all of the time because of constant headaches and you don’t wear them to the exam, you might lose credibility with the doctor.
Plan to arrive early. If you miss your appointment time, you may face consequences, such as having your benefits suspended. Make sure you give yourself plenty of time to get to your appointment.
Plan to bring a friend. You should plan to bring a trusted friend or relative with you to the exam. This person should not speak during the exam, but may take notes, provide you with emotional support, and act as a witness to the exam.
What Should You Do At the Exam?
Be polite. Even if the examiner has been hired by your employer or your state’s workers’ compensation agency, you should still be polite and respectful. Don’t assume that he or she is out to get you. And even if the examiner is less than friendly, responding with hostility can only hurt you.
Be honest and don’t exaggerate your symptoms. Examiners often have tests or other methods to help them determine how honest you’re being in reporting your pain, range of motion, or other symptoms. They also have years of experience examining injured people to determine if they are accurately reporting their pain. If you are caught exaggerating your symptoms, you will lose credibility and may have difficulty recovering the benefits that you’re entitled to. Rely on the diagnostic testing and other procedures you have had to support your injury. While you should avoid exaggeration, you also shouldn’t downplay your pain or symptoms to seem more credible. Just be honest, thorough, and accurate about what you’re experiencing.
Be honest about your limitations. Likewise, if you are asked about what activities you can and cannot do as a result of your injury, be completely honest. For example, don’t claim that you cannot drive anywhere if you have driven since your injury. It is possible that your employer or your state’s workers’ compensation agency has taken video surveillance of you over the last several months. If you say that you can’t drive and they have you on video driving, you will lose your credibility. Instead, if you are still having trouble driving, explain that you can only drive short distances.
Distinguish your previous injuries. If you have had a previous injury to the same body part, your employer and its insurance company likely will question whether your symptoms are due to the previous injury and not your workplace injury. Accordingly, it is important for you to explain how this injury is different. For example, if the earlier injury healed several years ago and you haven’t experienced any pain or symptoms for some time, tell the doctor that. Or, if you are experiencing new symptoms, more pain, or additional limitations due to this new injury, make sure to tell the doctor that.
What Should You Do After the Exam?
If you or a friend weren’t able to take notes during the exam, take a moment to write down what you remember about how long it lasted, what the doctor asked you, what tests the doctor performed, and so on. Remember that you may be under surveillance leaving the office, so don’t do anything inconsistent with your injuries or what you said at the exam.