General Principles Of An Independent Medical Exam (IME)

(Everything you need to know about an Independent Medical Examination before you schedule.)

 

“IME” is an acronym which stands for independent medical examination. An IME is an objective and unbiased assessment of a claimant in a workers’ compensation case. The purpose of an IME, is to assess issues such as degree of disability, causal relationship, treatment necessity, physical restrictions, and the claimant’s medical diagnosis. An IME is scheduled and paid for by the insurance carrier for the purpose of seeking an impartial opinion regarding the extent of the claimant’s injury. The claimant must attend the scheduled IME, otherwise he or she may risk facing a penalty.

 

An IME must be conducted by a qualified physician. What makes a doctor qualified? In the state of New York, an IME doctor must be approved by the New York State Workers’ Compensation Board. An approved list of registered IME physicians is located on New York State Workers’ Compensation website. The Board’s website also contains the contact information for all registered IME doctors. In order for a doctor to perform an IME, he or she must review a comprehensive summary of the claimant’s medical history. The claimant’s medical history may include past surgeries, injections, imaging studies, etc. The insurance carrier shall provide the IME physician with the claimant’s medical records. After performing the IME, the doctor must complete an IME-4 Cover Sheet to accompany their report. This form can be found on the New York State Workers’ Compensation Board website.

 

The location of the IME must be within a “reasonable distance from the claimant’s residence.” While this is a broad statement, the insurance carrier must interpret it fairly. For example, a claimant residing in Pennsylvania must not be expected to attend an IME in New York. Legally, the claimant has a right to be reimbursed for any travel expenses accumulated if the IME was scheduled by the carrier/employer. The claimant must also receive notice of the scheduled IME at least 7 days (1 week) prior to the date of such exam. Once the IME is completed, the physician is required to submit the IME report within 10 days of the examination. The IME report must be mailed to all parties involved in the case. For instance, the IME must be sent to the claimant, the claimant’s attorney, the insurance carrier, the insurance carrier’s attorney, and prior treating doctors.

 

Scheduling an IME may help the insurance carrier or the Workers’ Compensation Board evaluate the value of a claim. Additionally, the IME doctor’s medical opinion and pertinent findings may result in the denial, termination, or reduction of the claimant’s benefits issued by the Workers’ Compensation Board. As such, the outcome of an IME may significantly impact the issuance of Workers’ Compensation benefits, and may be beneficial to the carrier’s defense.