An Independent Medical Examination, or IME, is a process where the insurance company requires you to see a doctor they choose, not your regular doctor. The name “independent” might make it sound fair, but keep in mind, this doctor works for the insurance company, not you. The purpose of an IME is to get another perspective on your injury, but it's not always in your favor. This doctor is there to assess your condition and, potentially, offer a different opinion than your treating physician. Whether it's to question how your injury happened or to re-evaluate the severity, the insurance company uses these exams to check up on your claim—and possibly to cut back on the benefits you're receiving.
So, why does the insurance company send you to an IME in the first place? Simply put, they want their own doctor to evaluate your condition. Your regular doctor might say you’re completely unable to work, but the insurance company might want a second opinion to confirm—or challenge—that. The IME doctor might be asked questions like: Was the injury really caused by the accident? Is the diagnosis accurate? How severe is the disability? In other words, they’re looking for any reason to reduce or deny your claim. While it can feel frustrating, attending the IME is crucial because skipping it can seriously hurt your case (more on that later). The insurance company needs this information to decide how much compensation you should get—or if you should get it at all.
When you show up for an IME, the process might feel pretty straightforward, but there’s more going on behind the scenes. The IME doctor will review the medical records the insurance company provides, ask you about your injury, and perform a physical examination. However, keep in mind, this doctor is working with a specific goal in mind—answering whatever questions the insurance company has. This might mean evaluating your level of disability or reassessing your diagnosis. In some cases, the doctor might even follow detailed instructions from the insurance company, which could make the exam feel a bit less open-ended than a normal doctor’s visit. It's not uncommon for these exams to seem quick or even rushed, but everything said and done during the appointment can have a significant impact on your claim.
Skipping an IME? That’s a big no-no. If you refuse to attend or simply miss the appointment without a valid reason, the insurance company will almost certainly use it against you. They can request a hearing, and if the judge sees you’ve missed multiple IMEs without a good explanation, your workers' compensation benefits could be suspended. Imagine walking into court, and the judge tells you, “No more benefits until you show up to the next IME.” Not a good situation.
The bottom line is, if you’re scheduled for an IME, you need to go. If you’re sick or truly can’t make it, call the number on your appointment letter to reschedule. Just make sure you don’t abuse that option, or it could raise red flags with both the insurance company and the judge.
It’s important to be aware that not all IME doctors are completely neutral. Since these doctors are hired by the insurance company, there might be an inherent bias in their evaluations. While some doctors perform IMEs fairly, others may downplay the extent of your injury, question the need for ongoing treatment, or minimize your level of disability—all in favor of the insurance company. This can have a huge impact on your case, affecting not only your medical benefits but also the financial compensation you receive.
Remember, the IME doctor’s report can be used to reduce or even deny your claim, so it’s important to keep this in mind as you prepare for the exam. Knowing that bias might be at play helps you stay alert and ready to protect your rights throughout the process.
Honesty is critical when it comes to your IME, especially when talking about your medical history. If you’ve had a past injury or medical condition—even one you think might not be relevant—you need to disclose it. Insurance companies are looking for any reason to challenge your claim, and if they find out later that you failed to mention an old injury, they can accuse you of fraud.
Yes, it might feel like mentioning that old basketball injury from years ago could hurt your case, but trust me, it’s far better to be upfront. Being transparent now prevents the insurance company from claiming you were trying to hide something. When it comes to IMEs, it’s always better to be safe than sorry.
When you’re at the IME, it’s essential to give your best effort during the examination. If you hold back or act like you’re more injured than you are, the doctor might label you as "malingering," which is a fancy way of saying they think you’re faking or exaggerating your symptoms. This can seriously damage your case.
Even if you’re in pain, give 100% during the physical tests. If something genuinely hurts, be honest about it, but don’t try to push past your limits. The key is to be cooperative, clear, and consistent—anything less could give the insurance company an excuse to minimize your injury or reduce your benefits.
Feeling uneasy about attending the IME alone? You’re not the only one. The good news is that you can bring someone with you to witness the exam, and it’s completely within your rights. Having a friend or family member there can provide extra accountability and peace of mind.
You can also record the IME for your own protection, but there’s a catch: you need to give the insurance company advance notice. The appointment letter will usually have instructions for how to do this. Keep in mind, recording the exam might make things a bit more tense, but it also ensures the doctor stays on their best behavior. If it helps you feel more comfortable and you follow the proper steps, recording can be a great way to promote fairness and accuracy in your IME.
Wondering how often you’ll have to attend an IME? The truth is, there’s no set limit. The insurance company can schedule an IME at almost any point during your workers' compensation case, and they can even send you for multiple exams if they think it’s necessary. However, they won’t go overboard with it—these exams cost the insurance company money, so they’ll usually space them out to avoid unnecessary expenses.
That said, some insurance companies might schedule IMEs more frequently to keep tabs on your condition as your case progresses. If it feels like you’re being sent to the same doctor over and over, don’t be discouraged. As frustrating as it may be, attending all these appointments gives your lawyer the opportunity to challenge any patterns of unfair or biased conclusions the doctor may be making.
Preparation is key when it comes to your IME. First off, the insurance company is required to give you at least seven business days' notice before your exam, so use that time wisely. Talk to your lawyer and your treating doctor to understand the purpose of the IME and what to expect.
It’s also helpful to know that IMEs are often not like your typical doctor’s visit. Don’t be surprised if the waiting room is crowded and your actual time with the doctor feels rushed. That's why it’s important to take notes—jot down when your exam starts and ends, and any key details about what happens. These notes can be invaluable if you feel the IME report later misrepresents the exam or if your lawyer needs to challenge the findings.
Your behavior during the IME can have a significant impact on the outcome, so it’s important to handle yourself well. First and foremost, show up on time and be polite. Even though the doctor works for the insurance company, treating them with respect can help ensure a more neutral interaction. If you’re rude or uncooperative, you’re more likely to get a bad report, and that can hurt your case.
When answering questions, keep your responses short and to the point—don’t offer up more information than what’s asked. Stick to the facts, especially when describing your accident and symptoms. And be sure to give a consistent account of your medical history. If they hand you a questionnaire, fill it out carefully and make sure to note any past injuries or conditions. The last thing you want is to be accused of hiding something.
Lastly, if any test or movement causes pain during the exam, don’t push through it—be honest and tell the doctor when it hurts. This way, you’re not accused of exaggerating or giving suboptimal effort.
Believe it or not, the insurance company might be keeping an eye on you before and after your IME. It’s not uncommon for them to conduct surveillance to see if your behavior matches what you’re claiming in your workers' compensation case. They might film you leaving your home, arriving at the IME, and even going about your day afterward.
For example, if surveillance footage shows you carrying heavy shopping bags after the IME but you told the doctor you can barely lift anything, it won’t look good for your case. This is why consistency is key. Be mindful of your actions and ensure that your behavior accurately reflects your injury. It’s not about being paranoid, but just knowing that they could be watching, and they’re likely looking for any inconsistencies.
If you receive your IME report and feel that it doesn’t accurately reflect what happened during the exam or is biased against you, don’t panic—you can fight back. First, make a photocopy of the report for your records. Then, go through your own notes from the exam and compare them to the doctor’s report. Did the doctor skip a test they claimed to have performed? Did they say you had no trouble moving when you clearly did? Write down every discrepancy you notice.
Next, share this information with your lawyer. They can use your notes and observations to challenge the IME report, especially if it’s clear that the doctor didn’t conduct a thorough or fair examination. The more details you provide, the better equipped your lawyer will be to address any inaccuracies and protect your rights.
Dealing with an Independent Medical Examination can feel overwhelming, but you don’t have to navigate it alone. If you have questions or concerns about your IME or anything related to your workers' compensation case, I’m here to help. Feel free to give me, Rex Zachofsky, a call at 212-406-8989. We can talk through your situation, and I’ll do my best to guide you in the right direction. No pressure—just a conversation to make sure you’re taking the right steps to protect yourself.
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