Man is receiving an independent medical examination as part of a workers compensation claim

What Is an Independent Medical Evaluation?

Workers’ Compensation Lawyers

An independent medical examination — or the IME as it is known in common parlance — gives an insurance company and their chosen lawyer the mechanism and opportunity to have a doctor of their own choosing physically examine an injured worker. According to a workers’ compensation lawyer who is qualified to answer this, this examination also includes perusing the injured worker’s medical records and history, and perhaps conducting testing. As a result of these efforts, the IME physicians will (as it is planned by the savvy claims adjuster) formulate an opinion that they believe will be favorable to a position they have taken in the case.

The right to conduct such an examination is well recognized. There are really almost no circumstances where a judge would deny a request by a worker’s compensation insurance company, and/or their lawyer to have such an examination. The IME invariably occurs in essentially every workers’ compensation case. This is unlike the personal injury claims scenario, where it is only after a case progresses to litigation — and typically protracted and involved navigation — that an insurance company will pay for an IME in a personal injury matter.

The independent medical examination is utilized in three scenarios:

  • To obtain a medical opinion that the injured worker was, in fact, not injured;
  • To obtain a medical opinion the injured worker, while potentially injured in some minor fashion, did not sustain a permanent injury;
  • To obtain a medical opinion that the injured worker does not need a medical test or a medical procedure that has been recommended by another, usually the treating, physician.

Each of these are explored in turn.

Workers’ compensation insurance companies are well aware of the cadre of local doctors from which they can draw upon for the opinions they seek. These are typically medically conservative doctors that have rendered favorable opinions for the insurance company or the defense lawyer in the past.

The initial use of these doctors is to obtain a medical opinion that, although an injured individual has stated they were injured, reported an injury to the employer, and indeed receive medical treatment, nevertheless is in fact not injured. What one typically sees here is an opinion that there is “no objective evidence of injury”, or sometimes that “the injured worker is magnifying their symptoms out of proportion to the objective clinical findings” or, perhaps, less frequently that the injured worker “is engaged in the process of secondary gain” — this is the physician’s shorthand meaning that the person is faking their injury, so that they will receive money in the lawsuit or in a worker’s compensation proceeding.

The second scenario involves an insurance company using the IME processes to obtain an opinion that minimizes the injured worker. The insurance company’s goal here in to obtain an opinion that although an injured worker might have sustained some relatively modest, minor or superficial injury, the injury was not that serious after all. In this scenario, the doctor may opine that the individual injured worker is “at maximum medical improvement, needs no treatment, and has sustained no permanent injury, or disability”, as a result of their workplace accident.

The final situation where a defense IME is akin to another process often utilized by an insurance company to deny needed benefits to injured workers or injured individuals-the peer review in this instance. In this third scenario, a physician will be asked to examine the medical records of an injured worker who has been recommended to have a diagnostic test, a surgical procedure, or perhaps a course of physical therapy. Not surprisingly, invariably the IME physician will state test is not indicated or medically necessary, or that the procedure contemplated is no required. Sometimes, an IME physician agrees that the recommended procedure is needed, but that need is caused by anything other than a workplace accident.

If you have been injured at work, contact a workers’ compensation lawyer near you for help with your case.