Independent Medical Exams (IME)
Independent Medical Exams (IME’s) are usually one-time exams requested by the insurance carrier, TPA, injured employee, attorneys or an Industrial Commission. They are akin to a surgical second opinion. The IME Dr. will likely never treat the injured employee.
For many years IME’s seemed to hold more weight with the Industrial Commissions than they do today. Decision after decision from Industrial Accident Boards has pointed out the treating physician has seen the injured employee many times and possibly had possibly operated on him/her. IME’s can be very costly as usually the requesting party may likely pay much more than the fee schedule allows for the exam.
IME’s can cover compensability, permanent impairment rating, necessity for surgery, general treatment plan by the treating physician, medication management, and many other facets of medical treatment. The two that I have seen most are for a surgical second opinion and/or permanent impairment rating.
One of the trends that I have seen from Industrial Accident Boards or Industrial Commissions is to rule against the necessity of the IME or the conclusion of the IME if the jurisdiction allows the employer to choose the initial treating Dr. Would you expect a Deputy Commissioner or Judge to allow an employer or carrier to question the medical opinion of the employer-chosen physician?
Used properly, an IME can be a very good claims or risk management technique to keep treatment costs in check. They can also assure the injured employee they are receiving the proper medical care. Presently, I think that the Workers Comp adjuster or risk manager must be much more selective on the situations where an IME would be deemed necessary than in the past.
Bottom line – IME’s are worth it, but not in all situations where they once were seen as appropriate.
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