An independent medical examination, or IME, is an evaluation of an individual's physical and psychological symptoms to assess whether they are eligible for disability benefits or some form of compensation for a physical injury or psychological trauma.
Independent medical examiners, also known as IME Providers, are credentialed and certified experts who examine a patient to assess their physical or psychological health and level of functioning. Attorneys and insurance companies engage them in the context of litigation or when an injured employee files a workers' compensation claim.
IMEs are used for various purposes, including:
An individual might have to undergo an independent medical examination:
Insurance companies, workers' compensation insurers, and self-insured employers paying workers' comp claims have a right to request an independent medical evaluation.
When an IME is scheduled, the applicant will receive information regarding the date, time and place for the evaluation to occur.
Prior to the evaluation, the IME provider generally receives and reviews medical and psychological therapy records pertaining to the claim at issue. These records are used to help determine how much of the individual's condition and any resulting disability are due to the current injury and how much may be due to prior injuries or trauma. This is important especially in litigation or worker's compensation cases because the employer is only responsible for the portion of the injury or trauma that was caused by or occurred during the course of employment.
During the IME, an examiner may complete the following steps:
After the examination, the IME provider will submit a report that includes the following information:
An IME Provider may offer conclusions to some of the following questions at issue, including:
When psychological injury or trauma is claimed, an IME providers must be licensed mental health professionals—often psychiatrists or psychologists—who assess whether the individual has a mental health diagnosis that is eligible for compensation or other benefits. Examiners are required to provide independent and objective evaluations. They should not be directly involved in patient care or order treatment and provide ongoing care to the individual being evaluated. A mental health professional who has previously cared for an individual may not serve as the independent medical examiner in their case.
In a mental health IME, there is no therapist-patient relationship and no requirement of confidentiality. Unlike a traditional psychiatric or psychological evaluation, the examiner's role is to assess the validity of an individual's claims of injury or disability, as opposed to providing treatment.
Eligibility to become an IME provider depends on state laws, insurer policies and criteria, or federal requirements in federal disability cases. California law allows psychologists to act as IME providers and assess an individual for mental health conditions.
An IME provider must always be qualified to diagnose the condition in question. Where litigation is involved, there may be several examiners or other expert witnesses who may offer contradictory theories or conclusions. All parties involved are allowed to question the qualifications of the other party's IME provider or expert witness. Parties may also challenge the scientific basis for the opinions in the IME through a Daubert motion, which is named for the Supreme Court case that established standards for expert witnesses.
In most states, requirements to be an IME provider include:
Attending and graduating from college, medical school or an advanced graduate degree program State licensure to practice Becoming credentialed with an insurer and/or establishing a business as an independent contract independent medical examiner
All independent medical examiners should comply with state rules and their local licensing board's guidance. There are ethics hotlines available to answer questions about an IME provider's duty to patients.
The guidelines about who can select the IME provider can vary from state to state. Sometimes an individual can select their provider but, in many cases, an insurance company or self-insured employer gets to select the examiner. If there appears to be bias in the selection, an individual filing for workers' compensation or disability may want to consult an attorney to help protect their rights.
Under California state law, it states:
In any case in which a plaintiff is seeking recovery for individual injuries, any defendant may demand one physical examination of the plaintiff, if both of the following conditions are satisfied: