What Is an Independent Medical Examination for an Injury Claim?

An evaluation from a doctor other than the victim’s doctor may be required in a personal injury case. This is known as an “independent medical evaluation” or, more commonly, an “independent medical examination” (IME).

Serious injury accidents can involve significant financial compensation, either from:

• The person at fault
• Your own insurance company
• Your employer’s insurance company if you are an injured worker
• Someone else’s insurance company

Defendants may be responsible for paying the costs of physical injuries from an accident. They will want to verify any injuries before a jury determines how much compensation to award the victim for their damages. In these cases, speak with a personal injury attorney to understand your rights and the potential value of your claim.

What Is the Purpose of an IME?

The goal of an independent medical exam is to avoid bias in an insurance claim or personal injury lawsuit. An IME aims to get a more objective assessment of the victim’s injuries.

You may be examined and treated by your own doctor after an accident. One concern is that a doctor who has worked with you personally may be somewhat biased in reviewing the extent of your injuries.

The party being sued for compensation for the victim’s injuries may want to have an independent physician examine the victim or provide a second opinion. This also applies if the victim has not yet been examined.

The independent physician may examine the injury victim to:

• Make sure the victim did indeed sustain injuries
• Affirm that the injuries are as serious as the victim claims
• Make sure the injury claim is not attributable to a different cause

If the accident involves workers’ compensation to pay for medical treatment or ongoing treatment for a medical condition, such as a new disability, an independent medical examiner report (IME report) can be required.

The Role of the IME Doctor

An IME doctor is a medical professional who conducts an independent medical examination. Their role is to provide an unbiased assessment of the injured person’s physical condition and the extent of their injuries following an accident.

This assessment includes:

• A thorough physical examination
• A review of the claimant’s medical history
• An analysis of their medical records

The IME doctor’s findings are then reported back to the insurance company or civil court as needed. While the IME doctor’s role is to be neutral, they are often chosen by the insurance company. This could influence their findings.

Can I Refuse To Get an IME?

Though you can technically refuse to get an independent medical opinion, a refusal will usually undermine your claim. If an injured party does not wish to attend an independent medical examination, they may be compelled to do so in certain circumstances. Many states have passed laws allowing insurance companies to compel an independent medical examination when a claim seems questionable.

Your refusal may be due to unrelated reasons, such as privacy concerns or medical anxiety. But if the extent of the injury is a matter of debate, an IME may be necessary to provide both parties with the opportunity to get the facts. IMEs aim to keep the legal process fair to everyone involved.

Refusing an ordered IME can be enough to invalidate the claim. The other party may claim that your refusal implies that you’re being dishonest about your injury. An insurer may reject your insurance claim, depending on your policy terms. In a personal injury lawsuit, the judge may dismiss your case.

However, you have rights against unreasonable IME requests. Traveling a long way to see a particular specialist is an example of a request that may be unreasonable, especially if there is a similar specialist in your area. The focus of the IME must also relate to the case without straying into your other intimate medical details. Your lawyer can review the case to protect you against intrusive, burdensome, and unnecessary exams.

When Can Insurers and Courts Order an IME?

An IME may only be compelled when the insurance policy contains language requiring the insured party to submit to an exam. The insured may not be required to submit to an exam if the circumstances of the exam would amount to an undue burden, such as requiring the insured to travel long distances from home.

Most states also have court rules that state a judge may order an independent medical examination under certain circumstances. Usually, an examination can be ordered if a person’s physical or mental injuries are in dispute. If a person claims to have physical injuries but only sues for damages to a vehicle, an examination would not be ordered.

Examinations may also be ordered in lawsuits other than personal injury claims. For example, an examination may be ordered in a child custody dispute to determine whether a parent is emotionally stable enough to maintain custody of a child.

What Constitutes “Good Cause” for an IME?

The term “good cause” in the context of an IME often refers to the legitimate reasons an insurance company or defendant may give to request such an examination.

These reasons could include suspicions about the following:

• The validity of a claim
• The severity of injuries reported
• Inconsistencies in the medical records

Rules of civil procedure usually dictate what constitutes good cause. A judge often determines whether these conditions have been met in a personal injury lawsuit.

The Relationship Between the Insurance Company and the IME

When an insurance claim is made following an accident, the insurance company often requests an IME to verify the extent and cause of the injuries claimed. The insurance company aims to ensure that the claims are legitimate and that the requested compensation aligns with the injuries sustained.

At any rate, it is a mistake to assume that the physician chosen by the other party is going to be neutral and independent. It is wise to consult an attorney before attending an IME.

While this process is a standard part of many personal injury cases, claimants should be aware that insurance companies may not always act in their best interests. That’s why legal counsel is appropriate in injury cases.

What Happens if an IME Is Ordered?

If an independent medical examination is ordered, the injured party may be required to submit to more than one exam. The party seeking to compel an examination is often required to pay for the examination. The injured party’s attorney may be allowed to attend the examination and hire a videographer to record the exam as well.

Who Chooses the IME Doctor?

Sometimes, the party attempting to compel the examination may choose the examining physician. In such cases, it is a misnomer to call it an “independent” medical exam. The physician is really the other party’s expert witness. Some states’ court rules recognize this and instead call it a “defense medical exam.”

Even if the other party chooses the medical professional, their selection must follow all applicable rules and procedures. For example, the Federal Rules of Civil Procedure specify that the doctor must be “suitably licensed or certified.“ For example, if you allege a traumatic brain injury, the IME doctor should be a neurologist or similar expert rather than, say, a gastroenterologist. A general practitioner may also lack the knowledge to accurately assess the specific type of injury.

How Does Medical History Affect an IME?

An individual’s medical history plays a critical role during an independent medical examination. The examining doctor will need to review the claimant’s past health records to accurately assess the extent of the injuries in question.

This includes understanding:

• Pre-existing conditions
• Prior injuries
• Overall health status before the accident

It can also provide context to the injury claim and help determine if the accident is the actual cause of the injury or if it exacerbated a pre-existing condition. An accident victim must fully disclose their medical history to the IME doctor. This is done to avoid discrepancies that might affect an insurance claim or lawsuit.

The Significance of Medical Records

Medical records serve as documented evidence of a claimant’s injuries and the treatment they received. They include:

• Reports from the treating doctor or treating physician
• Test results
• Doctor’s office notes

These records are essential in a car accident case, as well as in any other accident case. They provide concrete proof of the type of injury sustained and the medical treatments required. The IME doctor will review these records to confirm the validity and extent of your injuries.

How To Handle an IME as an Accident Victim

As an accident victim, undergoing an IME can be a stressful process. It’s crucial to remember that the examining doctor is there to evaluate your injuries, not treat them. They will likely ask detailed questions about how the accident occurred and the symptoms you’re experiencing. Their goal is to provide an objective assessment of your injuries for the insurance company or court.

Being honest and straightforward about your symptoms and how they affect your daily life is essential. Over-exaggeration or downplaying of your symptoms can affect the accuracy of the IME report and ultimately harm your case. It’s advisable to have your personal injury attorney present during the examination to ensure your rights are protected.

Get Legal Advice From a Personal Injury Lawyer Before an IME

If you’ve been injured in an accident and plan to recover money from someone else for your injuries, it is possible that you will be required to submit to an independent medical evaluation.

However, in order to better protect your rights, it’s in your best interests to meet with a personal injury attorney first. They will use their expertise to give you the best possible outcome.