An independent medical exam, or IME, is a medical evaluation performed by a health care professional who isn’t your provider. IMEs are common and are often requested by insurance companies, lawyers, employers, and government agencies.
IMEs can have a big impact on workers’ compensation claims and applications for disability benefits. In this article, we take a look at how IMEs are used in personal injury (PI) cases.
What Is an IME?
After you’ve been injured because of someone else’s negligence or intentional wrongdoing, you’ll typically see your own doctor for a diagnosis of your injuries and treatment. Then, if you file an insurance claim or personal injury lawsuit asking for compensation for your injuries (called “damages”), you’ll use your medical records as evidence to support your claim.
In most cases, your medical records are enough to negotiate a personal injury settlement. But when there’s a significant dispute about the seriousness and long-term impact of your injuries, you may be required to have a medical evaluation by someone other than your health care provider.
This so-called “independent medical evaluation” is really a defense medical exam. Your opponent in the insurance claim or lawsuit sets it up and pays for it. The purpose of the exam isn’t to treat your injuries, but rather to raise doubts about:
- how you were injured
- the extent of your injuries and limitations
- your treatment plan, and
- your credibility.
Don’t have an IME unless you’re required to by your insurance policy or court order. If you’re stuck having one, minimize the potential harm to your case by knowing what to expect and carefully preparing for the exam.
Learn more about the role of insurance in settling a personal injury case.
Do I Have to Have an IME?
Yes, you can be required to have an IME when:
- you’ve filed a claim against your own insurance policy, or
- you’ve filed a personal injury lawsuit.
First-Party Insurance Claims
Your insurance policy is a contract between you and the insurance company. Buried somewhere in the fine print of most policies is an agreement to have an IME at the insurance company’s expense when you bring a claim for benefits under your own insurance policy (called a "first-party claim").
Examples of situations where you might file an injury-related first-party claim include:
- you live in a no-fault car insurance state
- you’re filing a “personal injury protection” or “medical payments” claim, or
- you were in a car accident with an uninsured (or underinsured) driver and you have UIM coverage.
Read your insurance policy carefully to see whether you have to submit to an IME and what the terms are. If your policy requires you to submit to an IME and you refuse, the insurance company may deny your claim on the grounds that you’ve violated your contract. Instead, protect your rights before and after the IME so it doesn’t torpedo your claim.
Filing a Personal Injury Lawsuit
A personal injury lawsuit is a civil lawsuit you file in court. You might file a lawsuit after settlement talks with the insurance company fail or you might file a lawsuit right away. An important step in the lawsuit process is called “discovery.” During discovery, you and your opponent exchange information about the case.
Rules vary from state to state, but most states allow the person or business you’re suing over an injury to make you submit to an IME or risk having your lawsuit dismissed.
If you have questions about whether you’re required to have an IME, talk to a lawyer. A personal injury lawyer can help you understand the rules and the consequences of not submitting to an exam.
What Happens During an IME?
An IME is not like an exam you’d get from your own health care provider. Remember, the examiner isn’t your doctor and the purpose of the exam isn’t to treat you. Your opponent hires the “independent” medical examiner to report anything you say or do that might harm your claim.
With that context in mind, here’s a look at how a typical IME might go.
The IME Interview
The medical examiner (typically a doctor, but rules vary from state to state) will probably start out by asking a series of questions about the accident and your injuries. You should be cooperative and prepared to give:
- a general statement about how the accident or injury happened
- a description of your injury
- a history of the treatment you’ve received so far, and
- a description of your current symptoms.
You shouldn’t answer questions about who was at fault for your injury or questions about your medical history that are unrelated to the injury at issue (for example, questions about your reproductive health during an orthopedic exam of your broken wrist).
It's best to answer IME questions the same way you'd respond in a personal injury deposition—only answer the question asked. Here are some other general guidelines:
Don’t volunteer information. Be polite and cooperative, but don’t be chatty or volunteer information. Truthfully answer the questions the examiner asks and say nothing more. Like an interrogation by a detective, anything you say can and will be used against you.
Avoid guessing. If you don’t understand the question, ask the examiner to repeat or rephrase the question. If you make a mistake, correct it immediately.
Be precise. During the exam, you'll be asked to describe any pain and discomfort you've been experiencing as a result of the accident. Since pain is subjective, you need to paint a clear picture of what you're experiencing. Describe your pain by referring to specific areas of your body that hurt, categorizing the type of pain you're experiencing (sharp, searing, aching, dull), and relating movements and situations that make the pain worse. Don't understate your pain and the problems it causes you, but don't exaggerate either.
Be consistent in your words and behavior. Don’t forget that the examiner is watching you before and after the physical exam and looking for inconsistencies between your behavior and your stated symptoms. For example, let’s say you told the insurance adjuster that you can't turn your head to the right. The examiner may stand to your right and ask you a question. If you turn your head in that direction to look the examiner in the eye while answering, you've just given the insurance company a reason to doubt your story.
The Physical Exam
The examiner will likely do some kind of physical exam. Don’t be surprised if it’s very brief. The exam should be limited to the injuries you claim, it shouldn’t be a general physical exam.
You may have to perform physical tests, like a test to measure your range of motion. You need to put forth the same effort you would put forth for your own treatment team. Examiners are looking for you to exaggerate your limitations and pain.
If you can, get an agreement in writing about the scope of the physical examination. It’s best to know ahead of time—and object—to diagnostic tests like X-rays and MRIs and psychological tests.
Keep track of the exact amount of time the examiner spends on your physical exam. The examiner will likely prepare a lengthy report about you and your injuries despite having spent less than 30 minutes with you.
After the Exam
When the IME is over and you’ve left the examiner’s office, write down everything you can remember about what happened. Important things to note while they’re still fresh in your mind include:
- what questions the examiner asked you and your answers
- what tests or procedures the examiner performed
- how much time the examiner spent with you, and
- any inappropriate or unusual comments the examiner made during the IME.
How to Prepare for an Independent Medical Examination
The best way to prepare for an IME is to work with a lawyer who can tell you what to expect. A lawyer can even do a mock exam with you to put you at ease. You’ll also want to do some or all of the following prep for your IME.
Review your medical records. The examiner is entitled to review your medical records related to your personal injury claim. Don’t sign an open-ended release for the examiner to access all of your records. Sign a limited release for the months or years of your treatment related to your injury with an expiration date. Ask your providers to send you copies of any records they provide to your opponent and be sure to review the records carefully before your IME. Be prepared to answer questions about your medical history and treatment. You’ll want the answers you give during your IME interview to be consistent with your medical records.
Bring a lawyer, friend, or relative. If you’re represented by a lawyer, your lawyer or a designated observer may attend the exam with you. If that’s not possible, see if you can get a friend or family member to go with you to your appointment to take notes and be a witness if you end up having to counter a negative report. At a minimum, find out if you can audio record the IME so you can have an objective record of what you and the examiner said.
Get organized. One way to feel more confident during the exam is to gather your thoughts on your medical history, the accident that led to the claim, your resulting injuries, and the impact your injuries are having on you. Write notes and bring them to the exam if it helps.
Remember what you're getting into. Never forget that this examiner has been selected to perform the IME because of a pre-existing professional relationship with your opponent. This is not to suggest that all medical professionals who perform IMEs are unethical, but it's safe to assume that the examiner isn’t in your corner.
Honesty is the best policy. Be polite, cooperative, and above all, truthful. If you appear to be embellishing an injury during the exam, or if findings from the exam don't match up with your stated symptoms, the examiner is likely to mention that prominently in the report.
Practice. Before the IME, practice talking with someone about your injury, your treatment, and how your injury has impacted your life.
Get directions. Note the date, time, and place of your exam and the name of the person who will be examining you. Get any directions you need well ahead of time.
Arrive early. You'll be more relaxed if you arrive early for your appointment. Submitting to an IME is stressful enough, don’t add to your stress by showing up flustered.
How Will the IME Affect My Personal Injury Case?
After the IME, the examiner will prepare a report describing the exam and the examiner’s opinions about your injuries. The examiner (who was chosen and paid for by your opponent) is likely to conclude that:
- your injuries aren’t as serious as you say they are
- your injuries were caused by a pre-existing condition or your own carelessness, and
- you already have or soon will recover from your injuries entirely.
In other words, be prepared for some bad news in the IME report, but don't forget to keep in it context by considering the source.
How to Counter a Bad IME Report
If the IME report minimizes your injuries, you can counter it. Here are some talking points to cover during settlement talks or at trial.
The medical examiner is biased. Point out the true nature of the examiner’s relationship with your opponent. How many IME referrals does the examiner typically get from your opponent each year? How much is the examiner paid for each IME? Medical examiners don't want to bite the hand that feeds, so of course their reports minimize the extent of accident victims' injuries.
The report is based on incomplete information. Tally up the amount of time your treatment team has spent with you and compare it with the amount of time the examiner spent with you. Your doctor knows much more about you and your injuries than can be gleaned from a brief and superficial IME.
Talk to your own doctor. If you’re dealing with a bad IME report, consider having your doctor review it for medical accuracy. You could also hire your own independent medical professional to examine you and write a report. Talk to a lawyer before you decide whether to go down this road.
Next Steps
If your opponent has asked you to have an IME, the stakes of your case are high. Perhaps you’ve filed a personal injury lawsuit, or you’re asking for a significant amount of compensation for your pain and suffering in a first-party insurance claim. Either way, you should talk to a lawyer.
A lawyer can tell you whether an IME is mandatory and help you prepare for the exam if it is. Learn more about what a personal injury lawyer can do for you.
Robert A. Johnson is a partner at a Minneapolis firm that provides legal services to individuals, families, businesses and organizations nationwide. His practice areas include personal injury cases and motor vehicle accidents.