Handling the Independent Medical Examination (IME)

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Partner at Fenner & Boles | Experience Matters
At some point, you may be required to attend an independent medical evaluation (IME) at the request of your employer or its workers’ compensation insurance carrier. Under the Workers’ Compensation Act, you may be required to undergo such evaluations at six-month intervals.

Many physicians who perform such examinations at the request of insurance companies will be willing to give you a “fair shake” if the physician believes you are being truthful, but many of these multi-millionaire doctors are controlled by the insurance companies. I wrote a chapter about this in my free book, The Wounded Worker: Inside the Pennsylvania Workers' Comp Maze. The following highlights the basic points. If you comply with the pointers outlined below, you will maximize the change that the physician who conducts the independent medical evaluation will not harm your legal interests.

1. TELL THE TRUTH

If you lie about your symptoms or provide an incomplete or false medical history, you will encourage the physician to write a negative report and raise credibility issues on your workers’ compensation case. If there are falsehoods or inconsistencies in the report prepared by your physician or in the report prepared by the independent medical examiner, the insurance company’s representative will argue that you are a liar.

Provide an accurate medical history to your physician and the physician who performs the independent medical evaluation. If you suffered prior orthopedic injuries, describe the nature, care, and treatment you received for these injuries. Only by providing an accurate history can these injuries be placed in a proper context. Because the insurance company will obtain any and all medical records pertaining to your pre-injury and post-injury history, all attempts to cover up or distort your medical history will be quickly revealed.

2. DON’T EXAGGERATE

The IME doctor will be looking for signs of exaggeration or malingering, as will be discussed in greater detail below. It should be sufficient to state that you are not capable of “fooling” the examiner. Any attempt to exaggerate your symptoms will be quickly revealed, to your great disadvantage.

3. GATHER YOUR THOUGHTS

Think about the history of your work injury, your symptoms, the treatment you received, and the activities associated with your symptoms. Think of the best way to describe your symptoms, and try, as much as you possibly can, to find a way to describe the exact location of your symptoms. If you have medical records available, review those records prior to the examination.

4. ANSWER THE QUESTIONS ASKED

Respond to the examiner’s questions, but do not unduly elaborate.

5. BE ACCURATE

It does not help for you to describe vague symptoms. Although it may be difficult at times to find the words which best describe your symptoms, do the best that you can.

6. RESPOND APPROPRIATELY DURING THE ACTUAL PHYSICAL EXAMINATION

Much of the independent medical evaluation will be spent reviewing your history and complaints of pain. The actual physical examination may take as little as 5 minutes and usually last no longer than 15-20 minutes. It is during this portion of the exam when injured workers most often make the mistake of exaggerating symptoms.

It is impossible for you to outwit the doctor during the physical examination. The physician hired by the insurance company is highly trained and will be looking for specific responses during the physical examination . Most orthopedic or neurological injuries have a typical set of symptoms associated with them. While every individual is different, there is a pattern of symptoms that are reproducible on physical examination. Unless you are a highly trained specialist, you will have no way of knowing what the examiner is looking for. If you claim that a particular maneuver by the examiner caused an increase in pain or other symptoms and these symptoms do not correspond to any known orthopedic or neurological abnormality, the examiner will note the IME report. Furthermore, the physician will perform tests that are designed to check for consistency. For example, individuals with low back injuries will be subjected to both a sitting root and standing root test. The sitting root test is done in the sitting position, and the standing root test is done either standing or lying down. This test is designed to place pressure on the nerves that exit the sciatic notch. If the tests yield different results, this will be noted as an inconsistency on examination and the examiner will suggest that the patient is feigning or exaggerating symptoms.

Similarly, if a patient claims that a particular maneuver by the examiner causes symptoms in another portion of the body that is anatomically distinct from the part being maneuvered, the examiner may claim that the patient is malingering.

At other times, the physician will perform “distraction” tests which are designed to determine whether your range of motion is consistent at all times.

The physician may use measuring devices to determine your strength. For example, individuals with hand or wrist injuries may be asked to squeeze on a measuring device. To test for consistency, the physician will do repeat testing. Any attempts to influence the outcome of strength testing will be noted.

In short, unless you are a physician, there is no way that you can “outwit” the insurance company’s physician and any attempt on your part to do so will be disastrous.

7. SCHEDULE AN EXAMINATION BY YOUR OWN DOCTOR

Because the insurance company may use the independent medical examiner’s report against you, you should see your doctor shortly after the insurance company’s’ examination to document your condition with a physician who will protect your interests.