Ngozi Chiekwu , MSN, PMHNP-BC

Integrated Health and Wellness Services, LLC

302-427-8000

1508 Pennsylvania Avenue
 Wilmington, DE 19806

Independent Medical Examinations

doctorWhen a worker is injured on the job, or has a work-related injury where company liability is an issue, a claims manager for the employer or the insurance company will often authorize an independent medical examination, or IME. This examination is designed to validate the claim before the employer agrees to provide compensation in personal injury or workman's compensation cases.The assumption is made that patients' own doctors may be biased in the patients' favor and may not give a totally impartial reports, so during an IME workers will be examined by doctors or therapists previously unknown to them.

The physician performing the IME has no prior relationship with the patient.The IME is set up to verify the patient's claim of the existence and severity of the injury or disease. The physician performing the IME will also assess whether or not that patient's difficulty is temporary or has resulted in a permanent disability, and whether it is the result of, or exacerbated by, some pre-existing condition. IMEs are performed by doctors who are independently hired and paid by employers or insurance companies. Individuals are required to undergo such examinations, but do not have to pay for them.

Reasons for an IME

Independent medical examinations may be performed for one or more of the following reasons:

  • To obtain direct knowledge of the injury or disease
  • To verify the degree of patient impairment
  • To verify the presence or absence of a pre-existing condition
  • To predict the nature and duration of necessary treatment
  • To justify reopening a claim
  • To close out a claim and deny further compensation
  • To appeal a claim
  • To meet a request for further evaluation.

Rules Governing an IME

While rules governing IMEs may vary from state to state or between jurisdictions, and may involve legal torts or workers' compensation, several general requirements are universal.

Notification

The worker must be given reasonable notice of the time, place and scope of the examination and informed of the identity of the examiner. Workers can only object to a particular examiner if there is a compelling reason. Except where there are extenuating circumstances, only one examiner will be allowed. The patient is required to appear for the examination. If the individual does not appear for the examination without rescheduling in the proper manner, a no-show fee may be charged or compensation may be denied.

Reimbursement

In most jurisdictions, the IME is paid for by the employer or the insurance company and the patient is reimbursed for lost work time and for transportation costs to and from the examination. If the patient has a disability, reasonable accommodations must be made for transportation and travel expenses.

Copy of report

The patient is entitled to a copy of the IME report within a reasonable length of time. A copy of the report must also be provided to the patient's doctors and other consulting physicians. It is assumed that the individual seeking compensation has authorized the independent physician to obtain any and all records and diagnostic test relating to the patient's medical condition. Patient-doctor privilege with respect to the condition in question is deemed to have been waived.

Availability for judicial examination

It is understood that both the worker and the independent medical examiner are subject to examination under oath by the claimant's attorney at any disposition, trial or hearing.

An IME Procedure

Independent medical examinations may include a physical examination focused on industry-related conditions and an investigation of any or all of the following:

  • Medical and family history
  • Previous injuries
  • Healing and pain level to date
  • Prior recreational, social or work activities
  • Patient's general demeanor and behavior
  • Patient's role in the accident, possible contributory negligence
  • Diagnostic test results
  • Records of doctor visits related to this injury
  • A detailed chronology of the accident itself
  • Functional interference of injury with daily activities
  • Potential interference of injury with job-related duties
  • Restrictions imposed by other medical professionals
  • Anticipated necessity for future treatment

There is some controversy surrounding independent medical examinations since the physicians who perform these tests are being paid by employers or insurance companies in whose best interests it is to minimize liability.

Additional Resources