Overview of An Independent Medical Examination (IME) and its Potential Impact on Your Injury Claim

If you have a personal injury claim in Massachusetts, whether it’s from a motor vehicle accident or a workers’ compensation claim, having to attend an independent medical examination (IME) at some point during your recovery is a strong likelihood.

Understanding why an insurance company may require an IME, how to prepare for the IME and the implications of the IME report are all very important to the success of your injury case. As you will see, the IME reports can have a significant impact on settlement and are utilized by insurance companies and insurance defense attorneys to avoid paying you the compensation or benefits you deserve. You should be familiar with IMEs to try and avoid hurting your injury case.

What Exactly is an IME?

An IME is simply a medical examination of you and your medical records or reports performed by a third-party doctor, who is not associated with your case. IME’s are usually ordered and scheduled by an insurance company and the injured party is generally required to attend the examination.  

Following the physical exam and review of your medical records, the examining doctor will author and issue a written IME report addressing the issues specific to each case. The issues normally addressed in any IME is the nature and extent of the injuries the victim suffered in the accident, whether or not the person requires further medical treatment and, in some cases, such as a workers’ compensation claim, the injured worker’s work capacity.

Why IMEs are Scheduled and How they may Impact Your Injury Case

An IME report can impact your injury case in many ways, depending on your specific injury claim. Let’s take a look at the most common situations where an IME is ordered and how it may impact an injury claim:

Massachusetts Motor Vehicle Accidents

You may recall from other blogs and articles we have written that in Massachusetts car accident cases your auto insurance company (or the insurance carrier for the car you were in at the time of the accident) has Personal Injury Protection (PIP) benefits. These benefits will cover up to $8,000 of the medical bills incurred for treatment of your injuries, 75% of lost wages and the costs of certain replacement services. For a more detailed discussion of PIP benefits from a motor vehicle accident in Massachusetts please see: What is Personal Injury Protection (PIP)?

After a car crash, your own insurance company may schedule an IME for you before continuing to extend PIP coverage to pay your medical bills or lost wages. So, as you can imagine, an unfavorable IME report will often result in your auto insurance company refusing to make payments for any additional treatment.

Recently, we were contacted by a resident of Canton, MA who was injured in a car accident on Interstate 95 in the Norwood, MA area. She was rear-ended, and liability was not much of an issue. Her auto insurance company scheduled and IME for her. It wasn’t much of a surprise that the IME doctor minimized her injury and opined that she had “reached a maximum medical improvement” and did not require an additional treatment. Therefore, her insurance company refused to make any additional PIP payments for medical treatment.

This can have a serious impact on your personal injury claim from a car accident. First off, your own treating physicians may refuse to treat you after the auto insurance company refuses to pay for the treatment. Your own health insurer may also refuse to pay for the treatment. When this happens, you may be stuck suffering from an injury and be unable to obtain necessary treatment.

Also, this can seriously affect any potential settlement of your accident case. The other driver’s insurance company may learn of the IME report and even obtain a copy of the IME report. You can bet they are going to use this in an attempt to devalue your claim and pay you much less than you deserve.  

Workers’ Compensation Claims in Massachusetts

There are a few different situations in which an IME will affect a workers’ compensation claim:

An Injured Worker Filed a Claim for Benefits

A worker in Massachusetts, who is injured in a work-related accident on the job, is entitled to workers’ compensation benefits. Now, just because they are entitled to these benefits doesn’t mean the insurance company always offers them. In some cases, the injured worker must file a Claim for Benefits because the workers’ compensation insurance company refuses to pay disability benefits.

When an Employee’s Claim for Benefits is filed, the insurance company sometimes schedules an IME. Their strategy for doing this is usually to obtain the IME report before the Employee’s Claim gets to a Conference before an administrative judge. They will then use the report at Court to argue that the injured worker should not be entitled to disability benefits.

An Injured Worker is Receiving Disability Benefits

A workers’ compensation insurance company will sometimes order an IME when an injured worker is out of work due to his or her injuries and is receiving workers’ compensation disability benefits.

Sometimes the insurance company may want to discontinue or terminate the payment of disability benefits or modify the payments from temporary total disability to temporary partial disability. The insurance company will order an IME so they can later use the IME report to substantiate their request to discontinue or modify the disability benefits. The will want a doctor’s opinion that the injured worker is not disabled and capable of returning to work in some capacity (i.e., full duty or light duty with restrictions).

The Injured Employee Requires Medical Treatment

An insurance company will also want an IME report to contest or deny the medical treatment sought by the injured worker. Remember, workers’ compensation is required to pay the cost of the injured employee’s treatment through the medical benefits offered from the insurance coverage. In this situation, the insurance company wants an opinion by their doctor that the injured worker does not need additional medical treatment or that medical condition that is unrelated to the work accident. This way, they can deny any request for medical treatment.

Properly Preparing for Your IME

Being properly prepared for an IME is very important and can be the difference between a favorable or unfavorable result. These exams are relatively quick, which means you have limited time with the IME doctor.  You are probably one of many patients he is reviewing that day for the insurance carrier.  Taking the time to prepare for the IME is essential to conveying your injuries and symptoms to the doctor.  Here are some tips to follow in preparation of your IME:  

Know your injury and history of treatment.  Before attending your IME, make sure you take time to review and write down your exact injuries and symptoms, how and when it started, when you first sought treatment along with a timeline of the treatment received with corresponding names and addresses of the medical providers. Write down all diagnostic testing done, whether it be MRI, CT scans, x-rays and where they were performed. It is very helpful if you’re able to bring with you to the exam the results of those diagnostic tests. 

Our office regularly supplies our clients with important documents such as accident reports, emergency room notes, medical notes and results of diagnostic tests to bring with them to the IME. An IME doctor is much more likely to give greater weight to the examination of other medical providers that just your version of the events.

Know when and where your injury affects you. Be prepared to describe in detail how your injury affects activities in your daily life. Be able to explain to the IME doctor what daily activities, at work, at home, with child care, is limited or non-existent because of your injury. You can never be too specific. It’s perfectly appropriate to tell the IME doctor if you have trouble doing laundry or taking out the trash. Even detail activities you once enjoyed but can no longer do, such as golf, dancing, hiking, etc. 

Be prepared to give a detailed account of your medical history.  This is one area that goes directly to your credibility. Your past medical history is out there and can be referenced in a number of ways. IME doctors love to find something in your medical records you failed to tell them about. The suggestion is that you are less than honest. If you had past injuries, surgeries or injury related medical issues be upfront, be honest and be accurate. No one lives in a bubble.  You don’t want to say you didn’t have any back issues when you saw your primary care physician years before complaining of back pain. There will be notes of your visit and complaints.  In most cases your past injuries will have no effect on your present injury.

Know your list of medication prescribed. Along with your treatment history you should note all medications that have been prescribed, the dosage and number of times per day you are required to take them. Your list should include the prescribing physician and the reason why it was prescribed. Whether or not the medication was helpful and when during the day it was most needed.

Final Thoughts on IMEs

The impression you give to the IME doctor is important. That is why you should make sure to arrive to the examination on time, dress accordingly, and be polite and courteous. In other words, don’t give the IME doctor any further reasons to write anything negative about you in the IME report. Thank him for his time and if you feel the doctor didn’t ask about something significant to your injury don’t be afraid to comment. When you leave take a few minutes to write down everything that occurred and a summary of the conversation you had with them.       

One important thing to remember is that the IME doctors are not your treating physician and for the most part not your friend.  An insurance carrier sets up an IME with a doctor they pay to give an “unbiased” opinion.  The insurance carrier wants an unbiased opinion but never forget they are the one’s paying for the examination. It always reminds me of the old saying: “you get what you pay for.” This is why, most times, the IME report will favor the insurance company. In other words, the IME report will usually explain that the accident victim suffered a minor injury and that they are at an end with treatment and can return to work, at least in some fashion.

With the very serious consequences of an unfavorable IME report, anyone injured in an accident and required to attend an IME should speak with an experienced Massachusetts personal injury attorney. An experienced injury lawyer can help you prepare for your IME and deal with the insurance companies and any consequences of the IME report.

Experienced Massachusetts Personal Injury Attorneys Here to Help You

Mahaney & Pappas, LLP is an experienced personal injury firm that specializes in helping accident victims get the benefits and compensation they deserve. We have many decades of combined experience with personal injury cases and workers’ compensation claims.

If you have been injured in an accident, you should at least consult with an experienced injury lawyer to understand your legal rights and what benefits or compensation you may be entitled to. Feel free to contact us online or call (508) 879-3500 to schedule a free meeting to discuss your accident. We are happy to provide you with a complimentary case evaluation.