If your employer or its insurance company is disputing the nature or severity of your medical condition, you may need to undergo an independent medical exam, commonly referred to as an IME. The results of the IME can have a large impact on whether you receive a permanent disability award (and how much), so it is important to be prepared. This article will give you an idea of what to expect when you show up for your IME.
An IME is typically scheduled when there is a dispute about your work-related injuries, illness, or medical treatment. At your IME, a doctor who is not your treating physician will evaluate you to determine the severity of your medical condition, the treatment you need, and your ability to continue working. The information the IME doctor gathers can be used by the insurance company as evidence against you in your case. For example, the insurance company can use a low disability rating from the report to argue for a lower permanent disability award. (For more on permanent disability awards, see Workers’ Comp Benefits FAQ.)
Although an IME is supposed to be independent and unbiased, that’s often not the case. The insurance company usually selects the doctor, and the doctor gets paid for performing the examination. IME doctors often write reports that are favorable to the insurance company so that they can continue to get referrals in the future.
The IME doctor will begin by asking you a series of questions about your medical history, the nature of your job, the circumstances of your workplace injury, your symptoms and treatment to date, and your ability to return to work. In particular, you should anticipate questions about your health before your workplace injury. The doctor will be looking to see whether you had a preexisting condition, unrelated to work, that caused your injuries. For example, the doctor may try to pin your back injury on a previous job, your recreational activities, or an old car accident.
During the entire interview, the doctor will be assessing your credibility and looking for signs that you are exaggerating or not telling the truth. The doctor will do this, in part, by watching your facial expressions and body language and deciding whether you seem like a credible, rational person. The doctor may also try to “catch” you in a lie by asking questions about your accident or symptoms and then checking your answers against accident reports and medical records. The doctor may also ask the same question several times throughout the exam, to see if your answers remain consistent. If the doctor feels like you are not being truthful during the interview, that will definitely be noted in the report.
After the interview, the doctor will conduct a physical examination. The doctor will likely start with a general health checkup by testing your blood pressure, listening to your heart and lungs, and checking your mouth, ears, nose, and eyes. Then, the doctor will focus on your specific injury. The nature of your injury will determine the type of exam required. For example, if you have an injured shoulder, the doctor will likely test your range of motion by manipulating your shoulder and seeing how well it moves. If you have a back injury, you may be asked to lift something so that the doctor can see how your injury affects your ability to perform your work.
As with the interview, the doctor will use the physical exam to determine whether you are telling the truth. IME doctors have certain tests that they may perform to see if your body’s physical reaction is consistent with the symptoms you are describing. The doctor may also perform several different manipulations during the exam and ask you to rate your pain each time, to see if your reactions are consistent. (To prepare for your exam, see Tips for Handling Your Independent Medical Examination for Worker's Comp.)
After the exam, the doctor will write a report summarizing the findings of the exam and any additional testing that you might need. The report will include the doctor’s opinion as to the nature and extent of your injury, as well as your ability to return to work. Because IME doctors often try to minimize worker injuries for the benefit of the insurance company, it is unlikely that the doctor will recommend new treatment or surgery. However, the doctor may give an opinion as to whether any treatment suggested by your treating physician is necessary.
In the report, the IME doctor will assign you a permanent disability rating. This rating is a measure of how much your injury impairs you, and it often determines how much you are entitled to in permanent disability benefits, if at all. In general, the higher your disability rating, the higher your permanent disability benefits will be.
The doctor’s report will be submitted to the insurance company, which will use the report in deciding what to pay on your claim. If you disagree with anything in the medical report, you can often get a second examination from a doctor of your choosing. If you're not able to settle with the insurance company, a workers' comp judge or other decision maker in your case will decide which report is more accurate.
Because the IME report is such an important part of any workers’ comp case, it’s best to consult with a lawyer beforehand. A lawyer can help you prepare for the exam, give you tips on how to handle difficult questions, and help you challenge an IME report that is harmful to your case. To find a qualified lawyer in your area, fill out a free case evaluation.