Health

What Is An IME? 5 Things You Need To Know

Medical Coverage

Published on January 31st, 2020

If you have ever been injured on the job and filed a Workers Comp claim, you know the answer to what is an IME. It is the acronym for Independent Medical Examination and is performed by a workers comp doctor.

Employees that are injured on the job can seek emergency care or go to their primary care physician to receive treatment. Once a worker’s comp claim is filed, the insurer may require you to visit one of their doctors.

Keep reading for five things you need to know about an IME.

What Is An IME?

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The independent medical examination typically occurs when the insurance company doesn’t agree with the findings of the initial assessment. Expect this to happen in cases where your doctor states your injuries are severe or permanent.

The exam is supposed to be an objective second opinion. In certain states, the patient can choose their worker’s comp doctor.

1. Your Claim Can Be Denied

Once you are informed you are required to be seen by a workers comp doctor, you must attend the appointment. Otherwise, your claim will be denied.

Take any paperwork you have received from your own doctor to the workers’ comp doctor visit. Discuss the prognosis and if the IME doctor disagrees ask for a definitive reason why.

2. An IME Supersedes Your PCP

Oftentimes the IME results will overrule the findings by your own physician or specialist. In this case, your claim will be denied. When this happens, request a copy of the IME’s full report.

Compare it to your doctor’s information and respond to any inaccuracies. If this does not change the outcome seek the services of a workers comp attorney.

3. The Workers Comp Doctor Works For Your Employer

It is important that you fully understand that the workers’ comp doctor does not work for you, in the way that your primary care physician does.

The doctor you will see as a result of an IME requirement works for the insurance company that will have to pay your claims. Their purpose is to minimize the impact on the carrier’s bottom line.

4. IME Doctors Are Fringe Doctors

The IME doctor you see maybe a fringe doctor. This is someone with the bare minimums to be considered a doctor. They may not have any experience in your type of injury.

5. You Could End Up With Out Of Pocket Costs

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Before agreeing to costly tests and procedures, check with the company’s workers’ comp insurance provider. Sometimes IME doctors receive incentives from service providers for patient referrals.

If the insurance carrier determines the services were not necessary, they can deny the claim. You will be responsible for the expenses.

IME Doctors Are Not On Your Side

Once you fully understand what is an IME, you’ll want to document everything that happens during your office visits.

Always be truthful. If you can take someone to appointments, do so. Getting back to 100% is your ultimate goal. Once you’re there, check out our tips for living a healthy lifestyle.