Independent medical examinations

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An independent medical examination (IME) is an evaluation performed by a doctor who is not involved in the patient’s care for the purpose of establishing medical and job-related issues.

The worker’s compensation insurance carrier or self-insured employer has a legal right to request an independent medical examination . Should an IME determine that the patient’s medical condition is not work-related, the insurer can deny the claim and refuse payment. But the insurer must have a physician’s medical opinion prior to denying a claim.

IMEs are often conducted for injured workers to determine the cause, extent and medical treatment of an injury. Most requests for IMEs are for discovering whether a worker has reached maximum benefit from treatment or whether any permanent impairment remains from the injury. While an independent medical examination involves a physician and a patient, an independent medical examination does not constitute the normal physician-patient treating relationship.

Although doctors conduct IMEs, they are often criticized for being neither independent nor a real medical examination. The former complaint is because the doctors are hired and paid by the insurance carrier or a self-insured company. Both the company and the insurer have a financial interest in the outcome of the review. The second is because an IME is different from what’s traditionally thought of as a medical exam, which is different than the type of thorough examination needed to provide a sound basis for important decisions about wage-replacement benefits and medical treatment for injured and sick workers.

Critics say that the independent medical examination is generally limited to the completion of a medical history by the claimant; a review of available documents provided by the treating doctor; a brief medical exam; the reviewing doctor asking questions about the claimant’s symptoms and recording his impressions regarding the case and describing the treatment required.

IMEs are also used for determinations used by insurance carriers in connection with paying medical bills and settling, arbitrating and litigating claims over wage-replacement benefits. They address questions regarding the final degree of disability. Insurance carriers also use IMEs as a safeguard against fraudulent suits and claims without merit.

References

• Statutory Definition
• Independent Medical Examination Article
• The Independent Medical Examination: Purpose and Process
• Independent Medical Reviews as an alternative to Independent Medical Examinations (IMEs)