What is an independent medical exam (IME)?

When you’re trying to get workers’ compensation benefits, quite a few parties come into play. In addition to your employer and their insurance company, you may need to visit multiple doctors. In addition to your treating physician, insurance may request a second opinion by ordering an independent medical examination (IME).

Theoretically, the IME is performed by a neutral, third-party doctor. But the insurance company often gets to choose the examiner. Since the cards might already feel stacked against you, it’s important to know what to expect and how you can set yourself up for success.

What is an independent medical examination?

An independent medical exam (IME) is an exam performed by a neutral, third-party doctor to confirm your medical condition for a workers’ comp claim.

The point of the IME is to get a second medical opinion. Usually the workers’ comp insurance company will order the exam, but you can also request one yourself. If the insurance company requests an IME, you will need to do it if you want to get workers’ comp benefits.

During the exam, the doctor will review your records, learn more about your health or symptoms, and then write a report for the insurance company. The appointment itself should be similar to other doctor visits you’ve had for your workplace injury or illness.

Related: Here’s How Much Workers’ Comp Pays in Every State

2 reasons why you might need an IME

Not every workers’ comp claim requires an independent medical exam, but it is common for the insurance company to order one. In some cases, you may want to request one if the insurer doesn’t. Let’s break down both scenarios.

Why the insurance company orders an IME

Most IMEs happen because the insurance company challenges the initial treating physician’s findings on your injury or illness.

If that doctor recommended something costly as part of your recovery — like an expensive diagnostic test or an involved surgery — your likelihood of an IME goes up. The same applies if the doctor said your disability will be long-lasting and seriously impair your ability to return to work.

In the end, the insurance provider wants to keep the cost of your claim as low as possible. That includes both the cost of your medical care and the weekly payments they’ll send to cover lost wages. So if the independent medical examiner recommends cheaper medical care or says you’re not as impaired as the first doctor asserted, the insurer will benefit.

Related: Situations When You Should Hire a Workers' Comp Lawyer

Why you might request an IME

The main situation when you may want to request an independent medical exam is when you disagree with the recommendation of the doctor who initially treated you. In that case, the IME gives you an opportunity to get a second opinion.

For example, if the treating physician reports that your injury will only keep you out of work for a couple of weeks, but you believe you’ll need at least a couple of months to fully recover, you may want to consider an independent exam.

Just keep in mind that you likely can’t pick the doctor for your IME. Some state laws allow you to pick the physician if you request an IME, but others don’t.

If you’re unsure whether requesting an IME could help you get the benefits you need, a workers’ comp lawyer can give advice on your options.

What happens at a workers’ comp IME?

An independent medical exam has three main phases, covering before, during, and after your appointment.

Before the exam

The first happens before you ever show up at the examiner’s office. The doctor gets a copy of your medical records plus other relevant materials, like statements you’ve given or information from the insurer. They review all of that before they see you. Now is also a good time for you to review the information that should be in your injury report.

During the exam

The second phase is the exam itself, which will vary depending on your situation. The examiner will ask about your injury and what caused it. They’ll try to learn more about the symptoms you experience. They’ll also try to assess your capabilities after the injury or illness. The doctor might use diagnostic tools to evaluate your condition, and they might ask you to perform certain tasks, like moving in certain ways or lifting an object.

Ultimately, the independent medical examiner uses their time with you to find out a some key things:

• Did you actually get hurt or ill in the course of your work, or did something happen when you were off duty?

• Did the treating physician correctly diagnose you?

• Are you as impaired as you or the treating physician said?

• Did the treating physician recommend the right course of treatment?

• How long should it take to recover from your impairment?

After the exam

After your IME, the doctor writes a report with their findings and sends it to the insurance company. The insurer will use this report when deciding whether to approve your claim or when determining your benefits. If you ever file a dispute, this report will also land in front of the judge deciding your case.

Learn more: How Long Can You Be on Workers’ Comp in Every State?

Who is the independent medical examiner?

The examiner is supposed to be neutral, so they won’t be your personal doctor or the initial treating physician for your injury.

You also might not have much control over who the examiner is. Laws vary from state to state but if the insurance company requests the IME, you likely won’t get to choose the doctor. Most state laws say that for an insurer-requested exam, one of two things happens:

1. The insurance company chooses the examiner.

2. The examiner is randomly selected from a list of medical professionals who have experience treating conditions like yours.

If you’re the one requesting the IME, you might be able to choose the examiner if your state law allows it, but they might also get randomly selected from a list of approved doctors.

How to prepare for an independent medical exam

Your medical exam can have a big impact on your workers’ comp claim, so you should take it seriously. The insurance company will use it to decide your benefits and if you contest your benefits, the report from your IME is sent to the court as evidence from an expert. Fortunately, you can be proactive and set yourself up for success.

1. Before your exam, request to see all of the documentation that’s getting sent to the IME doctor. This may be the only information they have about your injury. Review what they’ll see and be ready to discuss it in detail. If you think any information is incorrect, bring it up with the examiner.

2. Make a list of everything the doctor should know. That could include the time and place of the injury plus the frequency and severity of your symptoms. Go in prepared to help the examiner to clearly see your situation.

3. Keep conversation about your injury and ability to work. There’s no doctor-patient privilege here and everything you say can (read: will) get shared with the insurance company. There’s no need to bring up your personal life or your time outside of work unless it’s relevant to your injury. For example, you may want to explain that you have trouble getting dressed and cooking if you suffered an arm injury, but you don’t need to talk about going out with your friends or coworkers for a drink after work.

4. Be honest. Fight the temptation to inflate the seriousness of your condition or symptoms. If the doctor finds inconsistencies — or the insurance company does when comparing the IME report against the findings from your first doctor — you’ll hurt your credibility. And since getting benefits could come down to your word against either the insurance company’s or your employer’s, undermining your credibility will only make it harder to get the benefits you deserve.

5. Be polite to the examiner. The examiner’s report could help decide what benefits you get. Avoid insulting the examiner or being rude because it could affect what they put in their final report.

Can you dispute the results from your IME?

Yes, but it isn’t easy. You’ll need to prove that something in the IME report was factually inaccurate. If the doctor says your workplace injury is rooted in a preexisting condition but you can prove from your medical records that no such condition exists, for example, disputing the report will be easier.

If you have evidence of an inaccuracy, write to the doctor and insurance company with the evidence. You can request that the doctor adds an addendum to the IME report to clarify the situation. In some states, you can also request a second exam, which may give you more control over choosing the doctor.

Ultimately, if your workers’ comp case goes before a judge, they’re going to treat the IME report as expert evidence. So you’ve got a tough road to walk here. If you plan to contest the findings from your IME, it makes sense to bring in a workers’ comp lawyer.

Independent medical exams vs. functional capacity evaluation

The workers’ comp insurance provider might also have you visit a doctor for a functional capacity evaluation (FCE). Many people get both an IME and an FCE during the workers’ comp process, but they are distinct. The IME doctor determines if your injury should qualify for workers’ comp benefits. The FCE doctor determines how much you should get and for how long.

Get professional help with your workers’ comp IME

Here’s the thing: If the insurance company is contesting your workers’ comp claim or already denied it, it’s doubly important that you’re proactive about the independent medical exam. A favorable exam report could make the difference with your claim but in a lot of cases, the doctor performing the IME isn’t just chosen by the insurance company, they get referrals from them. In other words, they can be incentivized to have their findings benefit the insurer, not you.

A workers’ comp lawyer can help you navigate the IME, appeals, and any other roadblocks. To find out if a lawyer might be able to help your case move forward more quickly, take our quick workers’ comp benefits quiz.

If it looks like support could help your case, our team will reach out to learn more about your situation, help you understand your options, and connect you with an experienced lawyer from our network. Getting matched is free, you don’t need to work with our lawyers, and you never have to pay the lawyer until after your claim is approved or you get a settlement.