An independent medical exam, or IME, is a medical examination paid for and arranged by the insurance company. It’s performed by a doctor of the insurance company’s choosing who hasn’t been previously involved in your case. The purpose of an IME is to determine the extent of your injuries and whether your condition has improved since you filed your claim. IMEs are most often conducted when you have an ongoing injury claim with an insurance company, such as a workers’ comp or disability claim.
Doctors who are hired by insurance companies usually do an Independent Medical Exam. The doctor examines the patient and reviews their medical records. The insurer uses these exams to determine whether the patient is truly disabled and entitled to benefits. IMEs are usually ordered in these cases:
Your treating doctor will determine whether you are permanently disabled after a work-related injury or illness for a workers’ compensation claim. However, your employer’s insurance company may require you to undergo a medical evaluation with another doctor if they disagree with the findings of your treating doctor.
In order to qualify for disability benefits, an individual must have a significant impairment that has persisted for at least one year. In these specific instances, the patient’s medical records must establish incapacity. Such cases often require an independent medical examination.
A doctor will receive your medical records and any other documents relevant to your case, such as your injury report and personal statements. It will be up to the doctor to decide whether to review these documents before or after the examination.
The insurer may provide a letter about your injuries, current medical treatments, and questions about your health to the doctor. This letter allows the doctor to conduct the examination with you.
If you are injured in an accident, the doctor will want to know what happened and how badly you were hurt. They’ll also ask about any other medical conditions you have so that they can determine whether the accident caused your current injury. You’ll be asked a lot of personal questions that are important for determining whether your injuries are serious enough to warrant legal action.
During an IME, the doctor will ask about your current symptoms and your work history, other illnesses you have suffered from in the past and any medications you may be taking. You can expect that the doctor will discuss things like workplace exposures to chemicals and ways to prevent future problems with these exposures.
The IME may include a physical examination where the doctor looks for signs of possible injuries from working conditions or exposure to hazards on the job site. The examination also includes checking for visible signs of injury, such as bruises or scratches.
The IME physician will want to conduct a physical examination of your body or any specific part of your body that is in question. For example, if you are injured by repetitive motion at work, he or she may want to watch you move parts of your body while you do various tasks.
The doctor may ask you to do several things, such as:
- Moving the injured part in different ways, such as bending and straightening it
- Making a fist with the injured hand and then unclench it
- Wiggling each toe on both feet separately and then together
An IME is never optional, so it’s important to be prepared as much as possible and not let nerves get the best of you during the exam. This means having all your medical records available and being prepared to answer questions about your symptoms and medical history.
It also means knowing what kind of work-related injuries or illnesses you have had in the past, including how they were treated and whether they have resolved on their own or are ongoing conditions that may affect future work tasks. At the end of the IME, the doctor will write a report with their conclusions regarding the insurance company’s disputed claims.
Lying during an examination or at any other time regarding your injury or its consequences is absolutely unacceptable. The more polite you are during the examination, the better your chances of getting a positive outcome with your insurance company.
An Independent Medical Exam is a necessary step for anyone who wants to receive disability benefits. When you comply with the insurance company and the doctor, it can actually help you if you are entitled to receive compensation. If you suspect the insurance company is using the IME against you to delay or lower your benefits, an experienced attorney can work with you to resolve these issues with the insurer.