What is an Independent Medical Examination?

Injured at work? Chances are you will be able to recover workers’ compensation benefits, but receiving these benefits could come with some speed bumps. You may be asked to undergo an independent medical examination to verify either the extent of the injuries or the level of medical care needed to make a recovery. Here, we want to discuss why an independent medical examination may be necessary, as well as what happens at these examinations.

Helping You Understand Why an IME May Be Needed

Not all workplace injury claims are straightforward. Even though most individuals receive workers’ compensation benefits automatically without any pushback from an insurance carrier or an employer, there are times when disputes arise. Some of the most common reasons for disputes between an injury victim, their employer, or the workers’ compensation insurance carrier include:

• Discrepancies related to the severity of the injury
• Issues involving preexisting injuries
• Discrepancies about when a person can return to work
• Disputes over whether or not the injury occurred as a result of workplace duties
• Conflicts about the length of time a person is expected to receive compensation

Regardless of why a disagreement arises between an injury victim and their insurance carrier or employer, the worker may need to undergo an independent medical examination (IME) in order for the claim to proceed forward.

An IME is supposed to be conducted by a physician who has no stake in the outcome of the claim, but that does not necessarily mean the doctor is on your side. The goal of the examination is to resolve any disputes related to the workplace injury claim.

The IME doctor reviews all medical records related to the treatment the victim has received thus far. They will review the original diagnosis, analyze the current treatment, and review the treatment plans moving forward. The IME doctor will create a written report to turn over to the insurance carrier, and the insurance carrier will make the final determination about how they want to proceed with the claim.

What Happens At Your Independent Medical Examination?

Prior to initiating the Independent Medical Examination (IME), the examining physician receives all medical documentation related to the employee’s reported workplace injury. The reviewing doctor has the discretion to examine these records either before or after the physical assessment. 

These records are accompanied by an explanatory letter from the insurance provider outlining their stance on the case and treatment. This letter also requests the doctor’s opinion on the accuracy of the initial diagnosis, the work-relatedness of the injury or illness, the presence of any workplace-caused symptoms, and the existence of any lasting disabilities impacting the claimant. 

The injured party must review this documentation with their lawyer to rectify any inaccuracies and ensure the relevance of the insurer’s inquiries to their case.

The ultimate goal of the IME physician review is to resolve questions such as:

• When can you return to your job?
• Are you able to return to full duties?
• How long will you need to be away from work?
• Do you have a permanent disability that will affect your ability to carry out job duties for the foreseeable future?

Should You Have an Attorney Involved?

If you have been asked to undergo an IME and do not have an attorney helping with your claim, we encourage you to seek a free consultation with a lawyer today. A skilled workplace injury lawyer in Riverside can help evaluate your claim and discuss the best steps for you to take to help preserve the integrity of your case throughout the IME process.