If you’ve filed a workers’ compensation claim, you may be asked to attend an examination with a doctor other than your treating physician. These exams, which are called independent medical examinations (IMEs) in most states, can have a significant impact on the outcome of your case. So it’s important that you prepare for the IME, know what to expect, and follow a few simple guidelines for your conduct during the exam itself.
An IME is conducted by a physician who will give an expert opinion about any disputes in your workers’ comp case. Most often, your employer’s insurance company requests an IME (and selects the examining physician when it disagrees with your workers’ comp treating doctor about whether your injury or illness is work-related, whether any medical treatment (such as surgery) is truly necessary and appropriate, if and when you can go back to work, and whether you have any permanent disability. In some states, the workers’ compensation agency may order an IME, or you may be able to request one. You may have to attend several IMEs during your case. (To learn more about the selection of IME physicians, what happens during the exam, and how you can counter the IME doctor’s report, see What is an Independent Medical Examination and How Will It Affect My Workers' Compensation Case?)
Learn what the insurance company has told and asked the IME doctor. The claims adjuster for your employer or its insurer may write a letter to the IME doctor describing your injury or illness, summarizing the medical treatment you’ve already received, and asking specific questions about your medical condition that are in dispute. This letter frames the issues that the IME physician will address. You should ask to review this letter ahead of time, so that you can correct any mistakes about the facts of your case and make sure that the questions are appropriate. If possible, make your request in writing and file a copy with the office of the state workers’ compensation agency where your claim was filed.
Be familiar with your medical history. The IME doctor will likely have all of your relevant medical records, including records of previous injuries to the same part of the body that was affected by the recent workplace injury or illness. The examiner will ask you about all of these things, so take the time to review your medical history. Don’t try to conceal any previous injuries or downplay them, but do point out how your current condition is different than it was in the past, as a result of the recent workplace injury or illness.
Review how the accident happened. The physician 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 related to your job. Also, the IME doctor may be looking for inconsistencies in your story. Keep your answers brief, and make sure they’re 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 look over your notes and records to review the 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.
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.
Be polite. Even if the IME doctor has been hired by the insurance company or workers’ comp agency, you should still be polite and respectful. Don’t assume the examiner is out to get you. Even if the doctor is less than friendly, responding with hostility can only hurt you.
Be honest and don’t exaggerate your symptoms. IME physicians will often conduct tests or use other methods to help them determine how honest you’re being about your symptoms. They also have years of experience examining injured people to determine if they are accurately reporting their pain or limitations. If you’re caught exaggerating your symptoms, you will lose credibility and may have difficulty getting the benefits you deserve. However, 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, you should be completely honest if you’re asked about activities you can and cannot do as a result of your injury. For example, don’t claim that you can’t drive anywhere if you’ve driven since your injury. It is possible that the insurance company has taken video surveillance of you over the last several months. You’ll lose credibility if you’ve said you can’t drive but there’s a video that shows you driving. Instead, if you are still having trouble driving, explain that you can only drive short distances.
Distinguish your previous injuries. If you’ve 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 describe them.
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.
The IME doctor will write a report after the exam, and you or your attorney should receive a copy. Read it carefully and bring up any factual mistakes about your medical history or treatment. If you don’t have a lawyer, this is the time you should consult with an experienced workers’ comp attorney. Depending on the laws in your state, your lawyer may be able to request another IME with a different doctor to counter the first examiner’s opinion. Your attorney may also file objections, conduct a deposition to ask questions of the first examiner, and use all of the other available workers’ comp procedures for protecting your rights.