When you have a workers’ compensation case because of a work-related injury or illness, your treating doctor will make decisions about what medical treatment you need, when you can return to work, whether you have any permanent disability, and if so, to what extent. (Learn more about the role of treating doctors in workers’ comp cases.) But if there’s a dispute with your employer’s insurance company about any of these issues, you may be asked to undergo a medical evaluation with another doctor who is—at least in theory—neutral. The outcome of these exams, called independent medical examinations (IMEs) in most states, can significantly affect your workers’ comp case and how much you’ll receive in benefits. So it’s important to know how they work and what you can do to counter an IME report that goes against your claim or benefits.
An IME is a medical evaluation that is used to resolve questions about your medical condition (more on that below). Usually, the insurance company requests an IME because it disagrees with a decision by your treating doctor about your course of medical treatment (especially if your doctor recommends surgery or other expensive procedures) or the extent of any permanent disability. In some cases, the judge or hearing officer assigned to your case may also order an IME to resolve a disputed issue related to your case.
An IME is supposed to be an objective assessment of your medical condition, including what treatment you need, whether you have a permanent impairment and to what degree, and your ability to work in the future. However, whether your IME is truly objective may depend, in part, on how the doctor is selected.
The rules about these exams are complicated and vary from state to state. Usually, when the insurance company requests an IME, it also selects the doctor who will perform the evaluation. In this situation, there’s good reason to question the impartiality of these doctors, who receive their payment from the insurance companies and often rely on them for referrals. As a result, they have an incentive to lower the insurer’s costs (and your benefits) by minimizing the extent of your injury and your need for potentially expensive medical treatment.
Depending on the rules in your state, you may also have the right request an IME when you disagree with your treating doctor’s opinions—in which case you will usually be able to select the evaluating physician.
Some states have come up with different systems in an effort to make these medical evaluations more impartial. In these states, the examining doctor may come from a randomly selected list of qualified specialists or may be designated by the judge. Sometimes, the procedure is different if you have a lawyer.
Whatever the rules are in your state, you should consider consulting with a workers’ comp attorney if you’ve been asked to undergo an IME. Unless your case is simple or your injuries are minor, you may need the assistance of a lawyer to ensure that your rights are protected during the process.
Before the examination occurs, your medical records and any other documents relevant to your injuries (such as your injury report or statements you’ve given in your case) will be sent to the IME doctor. The doctor will decide whether to review the documents before or after the examination. If there is a hotly contested issue in your case, the insurance company may write a letter to the doctor explaining your injury, summarizing your course of treatment to date, and posing specific questions about your medical condition. These questions are used to frame the issues for the doctor.
The questions that might be asked include:
You should ask to review any letter sent to the IME doctor by the insurance company. That way you can correct any factual mistakes and make sure that the questions asked are appropriate in your case. Whenever possible, you should make your request in writing and file a copy with the state agency in which your workers’ comp claim is pending.
There is generally no expectation of a normal physician-patient relationship during an IME. This means that anything you tell the doctor is not privileged or protected in any way. Your statements to the doctor could even be used against you at a workers’ comp hearing if your case gets that far. The same goes for observations the doctor makes. For example, if the doctor sees you walking normally from your car to the office, but then sees you grimacing with pain and favoring one leg in the office, he or she will make a note of that. You can bet that this inconsistency will show up in the doctor’s report, and the judge or hearing officer will take this into account when assessing your credibility.
During the examination, the doctor will likely start out by asking you how your injury happened, what your relevant medical history is, and the course of your treatment so far. The doctor may also conduct a physical exam and tests (such as physical tests to measure your grip strength or range of motion). (For more on how to conduct yourself during the exam, as well as how to prepare for it, see our article on How to Handle Your Workers’ Comp Independent Medical Examination.)
After the IME, the doctor will write a report with his or her conclusions and opinions, particularly in response to the disputed issues or questions raised by the insurance company. You or your lawyer should receive a copy of this report. The results of the IME can have a large impact on your case. Workers’ comp judges and hearing officers often see IME doctors as “experts” and give significant weight to their reports. Judges also tend to view IME doctors as more objective than treating physicians—even if that’s not often the case. For these reasons, it can be difficult to discredit an IME doctor’s opinion.
However, there are some situations where you may challenge the IME report effectively. For example, if the doctor’s opinion is based on incorrect information about your medical history or there is some other factual mistake, point that out right away. You should write a letter to the doctor and the insurance company explaining the factual mistake and supporting it with documentation from your medical records, if possible. Request that the doctor clarify his or her report through an addendum. In some states, you can also request a second medical examination, performed by a doctor of your own choosing.
If you dispute the statements in the IME report and cannot get the issue informally resolved, and the IME is being used against you to limit or cut off your benefits, you should consult with a workers’ comp attorney right away. An attorney can help protect your interests by filing objections, scheduling a deposition to question the doctor, or requesting another examination.
For assistance finding experienced workers’ comp attorneys, use Nolo’s lawyer directory.