At some point during your workers’ compensation case, the insurance carrier may require you to attend an Independent Medical Examination, or IME. Despite the name, this examination is not independent in the way most people would understand the word. The IME is requested and paid for by the insurance carrier. The physician conducting the examination is selected by the carrier. The purpose of the examination is to provide the carrier with a medical assessment of your condition from a physician other than your treating doctor.
The IME is a standard part of the workers’ compensation process. It is not a punishment and it is not an indication that something is wrong with your claim. But it is an evaluation conducted on behalf of the carrier, and the results can significantly affect your benefits. Understanding what the IME is, what your rights are, and how to prepare is essential.
When the insurance carrier requests an IME
The carrier has the right to request an IME when you have been out of work for more than 30 days due to your injury. The carrier may also request an IME at other stages of the claim — when there is a dispute about the severity of the injury, when the carrier questions whether continued treatment is medically necessary, when the question of permanent disability arises, or when the carrier believes the worker may be able to return to work.
You are legally required to attend the IME if it is properly scheduled. The law requires at least seven days’ advance notice, and the examination must be held at a location within a reasonable distance of your home. If you cannot attend on the scheduled date due to a legitimate conflict, notify the carrier immediately and request a rescheduling. Do not simply fail to appear. Missing an IME without a valid reason can result in suspension of your benefits.
What happens during the examination
The IME physician will review your medical history, ask you questions about the injury, your symptoms, your treatment, and your ability to perform daily activities, and conduct a physical examination. The examination is typically shorter than a visit with your treating physician. Some IMEs last fifteen minutes. Some last an hour. The duration depends on the complexity of the injury and the thoroughness of the examining physician.
Be honest and be consistent. Answer every question truthfully. Describe your symptoms accurately — do not exaggerate them and do not minimize them. If a particular movement causes pain, say so. If a movement does not cause pain, say that too. The IME physician is evaluating your condition and your credibility. Inconsistencies between what you report during the IME and what appears in your medical record can be used to challenge your claim.
Do not volunteer information that was not asked for. Answer the questions that are asked. Be specific and factual. If you do not remember a particular detail, say so rather than guessing. And do not discuss the legal aspects of your case, your attorney, or your opinion about the workers’ compensation process. The IME is a medical examination. Keep it medical.
Your rights during the IME
New York law gives you specific rights during the IME process. You are entitled to at least seven days’ advance written notice of the appointment. The notice must include the date, time, and location of the examination and the name of the physician who will conduct it.
You have the right to bring another person with you to the examination. This can be a family member, a friend, or another individual. That person can observe the examination and can serve as a witness to what occurred during the visit. Having someone present provides an independent account of the examination if there is ever a dispute about what happened.
You have the right to videotape the examination. This right is established under New York workers’ compensation regulations. If you choose to videotape, bring your own equipment and inform the IME physician at the start of the examination. The physician cannot refuse to conduct the examination because you are recording it. A video record of the examination is one of the most effective ways to document exactly what occurred — what questions were asked, what physical tests were performed, and how long the examination lasted.
The IME physician must provide a copy of the report to you, to your treating physician, to the Board, and to your attorney if you have one. You are entitled to see the report and to have your treating physician review it.
How to prepare for the IME
Preparation starts before the day of the examination. Review your medical history so you can answer questions about your treatment accurately. Know the names of your doctors, the types of treatment you have received, the medications you are taking, and the dates of any surgeries or significant procedures. The IME physician may ask about your medical history before the work injury as well — prior injuries, prior surgeries, pre-existing conditions. Be prepared to answer those questions honestly.
If you have not already been seen by your own treating physician recently, schedule a visit before the IME takes place. Your treating physician’s most recent findings should be documented in the record before the IME report is generated. If the IME physician disagrees with your treating physician, the Board will weigh both opinions. Having a current, thorough report from your own doctor gives the Board something specific to weigh against the IME findings.
On the day of the examination, arrive on time. Dress normally. Do not try to appear more or less injured than you are. Bring a form of identification. If you plan to bring a companion or to videotape the examination, have your equipment and your companion ready. Do not bring your complete medical file to the IME — the physician should already have the records the carrier provided. You are there for an examination, not to present evidence.
What happens after the IME
The IME physician will prepare a written report. That report will contain the physician’s findings on examination, an opinion about your diagnosis, an assessment of your level of disability, an opinion about whether continued treatment is medically necessary, and an opinion about your ability to return to work. The report is sent to the carrier, to the Board, to you, and to your attorney.
If the IME report agrees with your treating physician’s findings, the carrier may continue your benefits without interruption. If the IME report disagrees — if it concludes that your disability is less severe than your treating physician assessed, or that you can return to work, or that further treatment is unnecessary — the carrier may use that report to reduce or discontinue your benefits.
A disagreement between the IME physician and your treating physician does not automatically mean your benefits stop. The dispute goes to the Workers’ Compensation Law Judge, who weighs both opinions along with the rest of the medical evidence. Your treating physician’s opinion is not automatically given more weight, and neither is the IME physician’s. The judge evaluates the thoroughness of each physician’s examination, the specificity of each physician’s findings, and the consistency of each opinion with the overall medical record.
This is why your treating physician’s documentation matters so much. A treating physician who has thoroughly examined you at every visit, who has documented your symptoms and limitations in detail, and who can clearly explain the basis for their medical opinions gives the judge a strong foundation to rely on. A treating physician with sparse notes and vague conclusions provides less for the judge to work with.
How Schwartzapfel Holbrook prepares clients for IMEs
At Schwartzapfel Holbrook, we prepare every client for the IME process. That preparation includes reviewing what to expect during the examination, advising on the right to bring a companion and to videotape, and ensuring the treating physician’s most recent independent clinical findings are documented in the record before the IME takes place.
After the IME, we review the report for areas of disagreement with the treating physician’s findings. If the IME report is used by the carrier to reduce or discontinue benefits, we prepare the case for a hearing before a Workers’ Compensation Law Judge. That preparation includes identifying weaknesses in the IME report, ensuring the treating physician’s documentation is thorough enough to withstand scrutiny, and presenting the medical evidence in a way that supports our client’s claim.
Schwartzapfel Holbrook / Fighting For You