What to Expect During an Independent Medical Evaluation in California

If your employer or an insurance company is disputing the extent or nature of your medical condition or permanent disability, you may need to undergo an independent medical evaluation, commonly referred to as an IME. The final IME report that is prepared by the IME physician who conducts the examination can have a huge impact on the outcome of your injury or permanent disability case, as well as whether you’ll receive a settlement or disability benefits.

When it comes to scheduling an IME, it’s important to be prepared. In this guideline, we’ll give you some insights on what to expect during an IME.

Understand the IME Basics

When there is a dispute about the work-related injuries, medical condition or illness of an individual, an independent medical evaluation may be scheduled to help answer the complex liability questions needed to resolve the dispute. An IME doctor will evaluate your medical history and your current medical state to determine the severity of your disability or medical condition, the treatment you need and your ability to continue working.

The information provided in an IME report can be used by the insurance company or employer as evidence against you in your injury or workers compensation case. For instance, a low disability rating can give the insurance company an edge over your claim by arguing for a much lower settlement or reduced benefits. IMEs are typically supposed to be unbiased and independent. Here’s what to expect during an independent medical evaluation in California.

The Interview

During the interview, the IME doctor will start by asking you a series of questions relevant to your medical history, the type or nature of your job, the circumstances of your work-related injury, your injuries and symptoms, the treatment you’ve had to date and your ability to get back to work. You’ll generally be asked questions regarding your current state of health before the IME doctor asks questions about your workplace injury. Understanding what to expect during an IME is important so you can prepare yourself adequately before an IME is scheduled.

The initial questions asked regarding your medical history will be looking to answer key issues such as whether you had a preexisting medical condition that’s totally unrelated to your work, that may have caused your injuries. For instance, an initial interview may pin your back or neck injury to recreational activities that you engage in, a previous job or an old car accident. During the interview, the IME doctor will be looking for any signs of exaggeration, and will be constantly assessing your credibility.

The IME doctor will check your body language, facial expressions and decide whether you’re making credible and rational claims. You may also be asked the same question throughout the entire interview to determine if you’re providing consistent answers. Expect questions to be asked about your symptoms or accident, and your answers checked against your medical records and accident or injury reports. If the doctor concludes that you’re not truthful during the interview, then that will be noted in the IME report.

How Should You Respond to the Doctor’s Questions?

The IME doctor is not there to find wrongdoing in your claim, but to provide a comprehensive and objective opinion about your medical condition, injury or permanent disability. You should be trustworthy, polite and corporate the best you can. Avoid being defensive or having an attitude when asked questions. Most IME interviews take around 10 to 15 minutes. Don’t fake or exaggerate symptoms as this can be quickly detected during a physical examination.

In case, the IME doctor provides a bad medical opinion that is not based on facts, you have the right to challenge it in court. But fighting with an IME doctor during the interview process will do you no good and even make your situation worse. Learning how to respond to IME questions correctly is critical to understanding what to expect during an IME.

The Examination

IME doctor

After the interview is done, the IME doctor will conduct a thorough physical examination. Usually, the doctor will begin with general health tests like checking your blood pressure, checking your mouth, eyes and ears and listening to your lungs and heart. After conducting general tests, the doctor will then focus on your specific medical condition or injury. The nature of your medical condition or injury will dictate the type of medical examination to be done.

For instance, if you have an injured hip, the doctor will likely test your range of motion by seeing how you walk or sit. If you have a spinal injury, you may be asked to lift something basic to see how the injury affects your overall ability to perform work-related tasks. Just like the interview, the IME doctor will use the examination process to determine if your injury claims are truthful. There are various tests that can be done to determine if your body’s physical reaction is consistent with the described symptoms you provided during the interview.

The IME Report

After the independent medical examination is done, the IME doctor will write an objective report summarizing the findings of the examination and any additional tests that you may need. The IME report will often include the doctor’s independent opinion and file reviews regarding the nature and extent of your injury or permanent disability, as well as your ability to get back to work. Considering that IME doctors work for insurance companies, they’re unlikely to recommend any form of treatment or surgery for your workplace injury, so knowing what to expect during an independent medical evaluation in California is vital.

However, they can offer a medical opinion on whether any form of treatment suggested or offered by your treating doctor is necessary. In the independent medical report, the IME doctor will usually assign you a permanent disability rating which is used as a measure of ascertaining how much your injury imparts you. The rating also determines how much you’re entitled to in permanent disability settlement or benefits, if at all your claim is credible. In short, the higher your permanent disability rating, the higher your benefits or settlement will be.

The final IME report is usually submitted to the insurance company which then uses the report to decide what amount to pay for your injury, workers compensation, civil liability or retirement disability claim. If you have issues with the report, most states allow you to get a second, independent examination from an IME doctor of your choosing. If you can’t reach a settlement with the insurance company, a liability claims judge will often decide which IME report is credible.

Getting Professional IME Services

Professional IME Services

Because getting an accurate IME report plays a critical role in your injury or workers compensation case, it’s recommended that you consult your lawyer. A qualified and experienced lawyer will help you understand what to expect during an IME interview and examination, and also provide some tips on how to deal with complex questions. The lawyer will also help you challenge any harmful or inaccurate report that could jeopardize your case.

To find credible and defensible IME services, consult Arrowhead Evaluation Services. AES is one of the most trusted IME service providers in California and boasts of an established and board-certified panel of IME physicians and medical expert witnesses specializing in different medical disciplines. For more details about our range of IME services, feel free to call us today.

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