If you file a workers’ compensation claim in Pennsylvania, your employer’s insurance company can require you to attend an independent medical exam (IME). This exam plays a major role in your case, so you must understand how it works before walking in the door.
What is an independent medical exam?
In an IME, a doctor chosen and paid for by the insurance company — not your treating physician — performs a physical evaluation. The insurer uses this exam to check your diagnosis, confirm your work restrictions or challenge your claim. Despite the name, this doctor does not work for you and often provides opinions insurers use to reduce or deny your benefits.
Do you have to attend?
Under the Pennsylvania Workers’ Compensation Act, you must attend these examinations, but the law legally limits the insurance carrier’s rights. An insurer can only require you to submit to an IME twice within a 12-month period (once every six months) unless a judge orders otherwise. If you miss an exam, the insurance company cannot automatically cut off your checks. They must first file a Petition to Compel with a Workers’ Compensation Judge, who determines whether to suspend benefits.
How to prepare
Bring a list of your symptoms, treatments and medications. Describe your pain and limitations honestly and consistently. Do not downplay your symptoms to seem tough, and do not exaggerate them either. The exam usually takes 15 to 30 minutes, so keep your answers clear and direct.
What happens after the exam
The IME doctor sends a report to the insurance company. If the report contradicts your treating doctor’s findings — such as stating you are fully recovered — the insurer will likely file a petition to terminate, modify or suspend your wage loss or medical benefits.
Protect your rights
You have a statutory right to have a healthcare provider of your own choice present to observe the exam. While you can ask to bring a friend or relative, the doctor decides whether to allow them in the room. If the resulting report is inaccurate, consult a workers’ compensation attorney immediately to file a formal challenge and protect your benefits.