What is an IME?

An IME is an Independent Medical Evaluation. The purpose is to confirm the original injury and treatment plan that the worker is following from the treating physician. In some cases, one may be ordered to dispute the worker’s claim of injury due to insurance fraud. 

The physician performing the IME is a neutral party to provide opinions about the injury, recovery, and treatment plan from an unbiased point of view. Prior to the actual evaluation, the doctor will review all current and past medical records provided to them. During the evaluation the physician will conduct an interview and thorough examination by performing various medical tests. Taking all information into account, the physician then writes a thorough report with his/her opinions about the injury, current medical status, work status, and treatment plan, if applicable. 

Typically, IMEs are ordered by insurance carriers, but defense counsel may also request them. 

Tell-Tale Signs That You Need an IME

If any of the following signs are true regarding your claimant, an IME may be necessary to obtain an unbiased opinion.

  1. If the worker is not healing as quickly as expected or their treatment plan doesn’t seem to be having an effect, yet the assigned physician will not release them back to work, it may be a sign you need an IME to resolve the issue. 
  2. During recovery, the physician or worker modifies the treatment plan to include additional body parts unrelated to the original work injury. An IME in this situation would help determine if the requests for additional treatment are reasonable, necessary, and most importantly related to the original work injury. 
  3. If the treating physician releases the employee to return to work with strict permanent restrictions, an IME can help determine if the permanent restrictions are warranted and/or appropriate. 
  4. If part of the treatment plan includes invasive procedures or expensive surgery that does not necessarily line up with the original injury, it’s essential for you to confirm that the treatment is reasonable and medically necessary. An IME would help to establish this prior to authorizing a surgery. 
  5. If the injured worker condition continues to get worse rather than better even after substantial treatment and ongoing medical care, an IME can help provide some insight into what is going on. 
  6. You obtain evidence that suggests a claimant can perform physical duties beyond the current restrictions assigned by the treating physician and/or show that they are capable of returning to work and performing their regular job functions. 

If you come across any of these six red flags, it may be in the best interest of the employer/carrier to schedule an IME. Having a clear and truthful understanding about the claimant’s current medical status is essential for determining the next steps in claims handling. Taking proper action with a pro-active approach can help return a claimant back to work quicker and save the employer/carrier thousands of dollars. JAG International is coordinating hundreds of IME’s a month on behalf of our clients. We have vetted over 450 physicians around the world.  Contact JAG International today for more information or to help you find a trusted Independent Medical Examiner for your next IME.