Independent Medical Examination
What Is Independent Medical Examination (IME)?
Independent medical examinations (IME) occurs when a physician/physical therapist or other clinician who has not established a previous doctor/therapist – patient relationship, examines an individual for the first time. IMEs are conducted to determine the cause, extent and medical treatment of a work-related or other injury from a liability issue to assess whether and individual has permanent impairment or has reached their maximum benefit from treatment. IMEs are usually requested by an employer or insurance carrier to acquire an independent medical opinion for the clinical status of the individual. Auto insurance carriers, self-insured employers and worker’s compensation insurance carriers have a legal right to request such an examination. If the doctor/therapist performing the IME concludes that the patient’s medical condition is related to a compensable event, the insurer may deny the claim and refuse payment.
What Happens During An IME?
Before your exam, all of your pertinent medical records and relevant documents to your injury will be sent to the IME physician. The physician may review your records before their exam or afterwards. If there is a contested issue, the insurance company may write a letter to the doctor explaining your injury, summarizing your treatment to date, and ask specific questions about your medical condition. The following questions may be asked to clarify your injury and treatment:
- Has has the right diagnosis been given? Does the patient actually have the condition you are claiming?
- Was the accident resulting in your condition work-related or exposure actually cause your current symptoms? For example, did your condition develop from personal activities or off-duty conduct?
- Is additional testing or medical treatment needed for your condition? If so, what treatment? For example, if your previous physician recommended surgery, is it appropriate?
- When would you be able to return to work if at all? Are there ay restriction to what work you can do (lifting certain weights or not standing for long period of time)?