What is an Independent Medical Examination (IME)?

personal injury | September 6, 2022

When a person sustains an on-the-job injury, they should be able to recover compensation for their medical bills and a portion of their lost wages through the workers’ compensation system in California. Unfortunately, there are times when employers or the insurance carrier delays or denies a claim, and they may require a worker to undergo an independent medical examination (IME) to verify injury severity were confirmed the extent of the medical care needed.

What is an Independent Medical Examination (IME)

Why Issues Arise After a Work Injury

Unfortunately, there are various reasons why an insurance carrier or an employer would dispute an injury or at least the extent of medical treatment needed after a workplace injury occurs. Often, this dispute revolves around whether or not the injury actually occurred, but what is more common is that there is a dispute that arises as a result of:

  • The severity of the injury
  • When a person will be able to return to work
  • Claims that the employee had a pre-existing injury
  • Disputes about whether or not the injury actually occurred at work
  • Conflict about how much or how long a person should receive compensation

Regardless of why a dispute arises between an injured worker and the insurance carrier or employer, the workplace injury victim may be asked to undergo an independent medical examination from a doctor that is supposed to be neutral.

The independent medical examination can dramatically affect how much compensation a person receives as a result of their work injury case. The goal of the IME is to resolve any discrepancies or disputes between the work injury victim and the insurance carrier or employer.

The doctor conducting the independent medical examination will review all of the medical records related to the treatment the victim has undergone up until that. The doctor will draft a written report that is turned over to the insurance carrier, and the carrier will make a final determination about how they wish to move forward.

Individuals who disagree with the insurance carrier and the findings of the IME can certainly challenge the report, though they should do so with the help of a Sacramento personal injury attorney.

What Happens At the IME?

Before the independent medical examination is conducted, all of the medical records related to the workplace injury up until that point will be sent to the doctor conducting the IME. This doctor may go through the records before they conduct an examination, or they may wait until after the exam is complete.

The insurance carrier will likely have already sent a letter to the doctor explaining the case and treatment, at least from their perspective. The insurance carrier will ask the doctor to make a determination about whether or not the injury or illness has been properly diagnosed, whether or not the injury or illness was caused by the workplace, as well as whether or not the current signs and symptoms are caused by the workplace injury or illness. Additionally, the insurance carrier will ask whether or not there has been a permanent disability that could affect the claimant.

Injury victims need to see the documentation sent to the independent medical examination doctor beforehand so they can work to correct any factual mistakes. The injury victim and their attorney should also review any questions asked by the insurance carrier to ensure that they are appropriate for the case