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Independent Medical Examinations
Independent medical exams are requested by the insurance company when there is a question about your injury, such as the type of treatment your doctor is recommending, whether you are able to work and the extent of your injury. The purpose is to get the unbiased opinion of an expert. The exam is done by a doctor who is not your regular doctor, and it’s not for the purpose of medical treatment.
An IME usually is used in litigation, where there is a dispute about benefits. If the insurance company requests an IME, they may be looking to deny your benefits, reduce the amount they are paying, or reject medical treatment such as your need for surgery. An IME report also can be used to help determine a fair settlement amount.
The job of the doctor performing the IME is to answer specific questions that the insurance company has. They will probably ask you a lot of questions, such as how you were injured, what type of pain you are experiencing and how it affects your ability to perform your job duties. They will also review your medical records and history. You may have to submit to tests, x-rays or range of motion exercises.
Submitting to an IME isn’t really optional, and it’s in your best interest to be cooperative. The best thing you can do is be honest and not exaggerate your injury. The insurance company may send a nurse case manager along for the appointment.
Many doctors who do IMEs are experts in their field and provide a solid evaluation of your work injury. However, there are some who may be influenced to tell the insurance company what they want to hear (that your injury isn’t as bad as you say it is, for example). The doctor should spend enough time with you to get a good idea of your situation and they should listen to you.
If you are facing an IME, you are probably at a point in your case where you would benefit from having an attorney. It most likely means there is a dispute and the insurance company is looking for ways to reduce what they’re spending on your claim. An experienced attorney – someone who has handled hundreds of work injury cases – will know how to fight for you.