During the course of treatment for a work injury, sometimes, a claims representative may decide to request a second opinion from another physician. This is where an independent medical evaluation (IME) comes in. Also referred to as an independent medical examination, an independent medical evaluation is conducted when an injured party requires third-party opinion and documentation, to determine the cause, extent and medical treatment of a work-related or other type of injury where liability is an issue.
An IME can be requested by different parties, including insurance companies, lawyers, benefit providers, employers or HR managers. An objective, independent medical evaluation report is provided after the examination is done to confirm or deny any benefits or settlements to the claimant. To understand what is an independent medical examination and IME report, we’re going to discuss a few things that you should know.
When is an IME Requested?
An independent medical evaluation is used to resolve complex questions related to your medical condition. Usually, it’s conducted at the behest of an insurance company or employer to get an independent opinion of an individual’s clinical status. When is an IME requested?
- If an employer or insurance company disagrees with a decision by your treating doctor about your course of treatment
- If there’s a dispute about the cause or extent of your injuries in a personal injury case
- If there’s a dispute about the extent of a permanent injury-related disability
- If the hearing officer who’s assigned to your case or judge orders an IME to help resolve any disputed issues related to your case
- In some states, you have the right to request an IME examination in case you disagree with the opinion about your medical condition or permanent disability by your treating doctor
Who Conducts an IME?
Independent medical evaluations are usually conducted by a qualified health care provider who has undergone professional IME training and been authorized and certified as an IME provider. The qualified IME provider or physician will analyze your entire medical history and include an independent opinion in the IME report. The physician should not have any previously existing or ongoing patient-doctor relationship with the individual undergoing the examination. IMEs are organized and managed by companies that offer IME services.
An IME company will often handle the independent medical evaluation process from start to finish. They are also responsible for finding highly-qualified, objective physicians who can conduct the examinations, and located within the examinee’s geographical location. They also prepare and obtain the evaluation reports from the physician and provide them securely and safely to the client. If parties involved have questions related to “what is an independent medical examination report?”, the IME providers or doctors take the role of explaining what it entails.
Who Chooses the Physician to Conduct an IME?
An IME is supposed to be an impartial assessment of your current medical condition, including what type of treatment you need, whether you have a permanent impairment and to what extent, and your ability to work in the future. The rules about who chooses the physician to conduct an IME are complex and vary from state to state. Whatever the rules are in your state, it’s advisable to consult your lawyer if you’ve been asked to undergo an independent medical evaluation. A lawyer ensures your rights are protected during the IME process.
What Happens During an IME Examination?
Before you undergo an independent medical examination, all medical records and any other documents relevant to your injuries or disability are sent to the IME physician. The doctor decides whether to review the documents before or after the examination. The client requesting the IME usually provides a written letter to the IME doctor summarizing your medical condition, the treatment you’ve undergone up to date and questions related to your medical condition.
Some of the questions that a doctor helps answer include:
- Whether your current symptoms are as a result of your work accident
- Whether the surgery or treatment recommended by your treating doctor is necessary
As an examinee, you should ask to review any IME letter that’s sent to the IME physician by your employer or insurance company. That way, you can verify if the questions asked are relevant to your case. The most important thing in IME examinations is to be honest, helpful and polite. Communicate openly with the IME doctor all the relevant information related to your injury. Although the doctor works for the defense, they’re bound by ethical standards to be impartial.
The IME physician typically conducts a patient interview to learn more about their medical history and as well as their accident or medical condition, and then does a thorough medical examination to come up with the right answers to the liability issues in your case. During the examination, an IME doctor will evaluate your:
- General appearance
- Signs of exaggeration or deception
- Objective and subjective manifestations of injury
- Other contributing factors
Arrive for your IME examination at least fifteen minutes early. Most importantly, consult your lawyer before your appointment. The lawyer may have some special advice about handling yourself during the IME, certain aspects of your disability or injury that you should be aware of or even about the doctor you’ll be seeing. Your lawyer will also address certain issues or subjects that you should not discuss during an IME, such as communications with your lawyer, your impressions of the defendant’s liability for your injury or the status of settlement negotiations.
Remember that the key purpose of an IME is to obtain accurate information and expert opinion for the sole purposes of litigation. The IME is not supposed to provide you with a second opinion or medical advice or treatment. You may be asked to sign a form indicating so. Even though an IME doctor offers you advice, you’re not obligated to take it. A huge part of understanding what is expected lies in understanding what is an independent medical examination and report.
How Does an IME Report Affect Your Case?
An IME report can have a huge impact on your liability case. The judges listening to worker’s compensation or other liability cases and hearing officers often see medical evaluation doctors as specialized experts and largely rely on their reports. IME physicians are often seen as more objective than treating physicians, so discrediting an IME doctor’s report can be hard. However, if the report is based on a factual mistake or incorrect information about your medical history, you can challenge the examination report by writing to the insurance company and doctor.
It’s advisable to do this with the help of a qualified lawyer, especially if the issue cannot be resolved informally or the issue limits or cuts of your benefits. A lawyer will help protect your interests by filing objections, requesting another IME examination or scheduling a deposition to question the doctor.
Get Professional IME Services at AES
Arrowhead Evaluation Services offers the most trusted independent medical evaluation services for attorneys and their claimants in California. We offer the largest network of experienced and board-certified IME medical experts with over 78 medical assessment facilities conveniently located throughout the Southern California area. If you’re looking for the most comprehensive, unbiased, objective and evidence-based IME services, don’t hesitate to call get in touch with us.