Facts About an IME Exam In Pennsylvania Workers Comp Cases

In nearly all Pennsylvania workers compensation cases that involve litigation, the injured worker must attend an independent medical examination (IME). Often I have clients ask just what is this examination all about. Here are a few facts regarding IME exams in Pennsylvania workers compensation.

  • ‘IME’ stands for ‘independent medical examination’, but in reality, it is an insurance evaluation examination. The examination is scheduled and paid for by the insurance carrier.
  • IME examinations serve the purpose of providing a workers compensation insurance carrier medical evidence in a workers compensation claim.
  • Insurance carriers are generally permitted to have an IME examination every six months.
  • The insurance carriers deliberately pick what doctors they want to perform specific evaluations. Although most doctors are honest, the fact remains that they have been selected by the insurance company to perform this exam because they have given favorable results in the past.
  • It is important to understand that most of these IME doctors are not in fact independent and have frequently done work for that insurance company. These doctors solicit business from the insurance companies by offering to do medical evaluations. They understand that too many unfavorable reports for the insurance carrier could lead to the insurance carrier seeking a new doctor.
  • Many times, an IME doctor will issue a report that typically states the injuries sustained are unrelated to accident, are pre-existing conditions, or that the claimant is ‘symptom exaggerating’.
  • It is important for injured workers to understand that the IME doctor is not there to TREAT the injury, but rather to simply issue a report to the insurance carrier.

With these facts explained, what makes an insurance carrier schedule an IME exam in a Pennsylvania workers compensation case? Here are several reasons they may do so.

  • The insurance carrier may be skeptical of the claimant;
  • The injuries or treatment provided may not be consistent with the mechanism of injury;
  • The insurance carrier is trying to limit the scope and extent of the injury;
  • The insurance carrier wants the injured worker injured party back to work;
  • The insurance carrier is trying to terminate medical treatment ;
  • The insurance carrier is questioning the reasonableness or necessity of any medical bills or treatment;
  • The insurance carrier is contesting the causal relationship between the accident and the medical treatment and/or injury.
  • The insurance carrier is trying to determine if any permanent injury has been sustained from an accident.
  • The case is in litigation and the insurance carrier needs a medical opinion.

The most important thing to understand is that if you receive a notice of an IME exam, seek an experience Pennsylvania workers compensation attorney right away. The insurance carrier is paying for the examination and they have a reason to do so. It is usually the beginning of hostile action against your workers compensation case.

If you have been injured at work and have received a notice of an independent medical examination, trust your local Central Pennsylvania workers compensation attorney at Mooney Law. We offer free consultations at any one of our 14 offices in Central Pennsylvania. Call today to schedule an appointment at 833-MOONEYLAW or 717-200-HELP.

Mark Buterbaugh

Attorney representing injured workers and Social Security Disability clients in Pennsylvania and Maryland.