What is an Independent Medical Examination (IME)?

If you’ve filed a workers’ compensation claim in New York, chances are you’ll be required to attend an IME at some point. But what exactly are these exams, and how should you approach them?

First, it’s important to understand IME doctors are not neutral third parties. Though termed “independent,” they are selected and paid by your employer’s insurance carrier to assess your condition from the payer’s perspective.

In this article, we’ll break down everything injured workers need to know about IMEs in New York workers’ compensation cases. You’ll learn why they are required, what to expect during the exam, and how IME reports impact your claim.

Why IME Exams Are Required in Workers’ Compensation

After reporting a work-related injury or illness, New York law grants you the right to medical treatment through your employer’s provider or your personal doctor. However, disputes often arise regarding the nature and extent of the injury.

To help resolve these disputes from the perspective of the insurer, an IME will be scheduled with a doctor of the carrier’s choosing.

Common scenarios include disagreements over:

• Causation – Is the condition work-related? Was the injury precipitated or aggravated at work?
• Nature and extent of impairment – What diagnoses are supported? How much disability is present?
• Treatment – Are requested therapies and procedures medically necessary?
• Work capacity – What limitations are warranted? Can workers perform their usual jobs?
• Apportionment – What percentage of impairment is due to this versus pre-existing or unrelated conditions?
• Disability rating – What is the percentage of permanent disability for potential impairment benefits?

While termed an “independent” exam, the IME doctor’s role is to evaluate you from the insurer’s viewpoint. But you must attend or risk benefits being terminated.

Getting Ready for Your IME Appointment

The IME appointment itself resembles a standard medical evaluation, though the doctor will have your full claim file. Be thorough in describing your injury, treatment, and impact on daily living and work.

To get ready for your IME appointment:

• Review your medical records so you can accurately describe your history, diagnoses, medications, test results, and treatments to the examiner.
• Be prepared to explain in detail which symptoms like pain, fatigue, weakness, or other limitations are preventing you from performing your job duties. Help the doctor understand how your condition impairs your ability to work.
• Arrange transportation or accommodations if needed based on restrictions from driving, sitting for long periods, etc.

After the examination, the doctor will send a report to the insurer addressing your functionality. Request a copy to ensure it accurately reflects your circumstances.

How IME Reports Influence Claims

While not binding, IME opinions heavily influence benefits determinations and often override your own doctors’ conclusions on issues like compensability, disability status, apportionment, and treatment requests.

But a seasoned NY workers’ comp attorney can refute questionable IME findings and ensure your rights are protected. Problematic reports are regularly overcome, delivering injured workers their rightful benefits.

Get Legal Representation to Level the Playing Field

IMEs present yet another hurdle for injured employees during an already challenging compensation process.

But, staying informed and retaining experienced counsel early on can help injured workers stand up to questionable insurer medical exams.

To discuss your options, contact us today. We’ve helped countless clients achieve fair outcomes following skewed IME reports. With us in your corner, you can focus on recovery, not bureaucracy.