If you filed a workers’ compensation claim after getting hurt on the job, you may receive a letter from the adjuster asking you to attend an independent medical examination (IME). You’re probably asking, “What is an IME in workers’ comp?” The request to attend an examination can feel confusing and stressful. You might wonder what the exam involves and why you need to have one when you have already been going to see your own doctor.
Understanding what an IME in workers’ comp really means can help you feel more prepared for what happens during these exams, why insurance companies request them, and how they can affect your claim. An experienced North Carolina workers’ compensation attorney can help you fulfill your obligations and protect your rights when seeking the benefits you deserve.
What Is an Independent Medical Examination?
A workers’ comp independent medical examination is a medical evaluation performed by a doctor chosen by your employer’s insurance company. Unlike your regular doctor, this physician does not provide medical treatment. Instead, they examine you and write a report about your condition.
The insurance company uses this report to make decisions about your workers’ comp claim. The doctor may provide opinions on the severity of your injury, your ability to return to work, and the type of treatment you require. While the exam is called “independent,” the insurance company pays for it and selects the doctor. That means the examiner may not be independent or see things the same way your treating physician does.
Why Do You Need to Attend an IME?
Insurance companies request an independent medical examination for workers’ compensation for several reasons. They may want a second opinion on your diagnosis or treatment plan in an effort to save themselves money. They might also want to know if you are really injured, if you are exaggerating your injury, or if your injury is genuinely related to your job.
Common reasons for an IME request include:
- Disputes about your injury – The insurer may question whether your condition connects to your work duties or if it was purely pre-existing.
- Questions about treatment – They may wonder if the medical care you are receiving is necessary or if there is a cheaper alternative.
- Return-to-work decisions – They want to pressure you to return to work faster than your treating doctor is willing to send you back or make your work restrictions easier to accommodate.
- Long-term claims – Cases that last many months often trigger IME requests.
The insurance company has legal authority to ask for this exam as part of managing your claim.
Can You Refuse to Attend an IME?
In most cases, you cannot simply refuse to attend an IME in workers’ comp without facing consequences. As long as you are claiming compensation, whether you are receiving it or not, North Carolina workers’ compensation law requires you to cooperate with reasonable requests from the insurance company. If you skip the appointment without a valid reason, the insurer may be able to suspend or deny your benefits (N.C.G.S § 97-27).
However, you do have some rights. You can ask for a different appointment time if the scheduled date creates a genuine conflict. You may also be able to request a different location if traveling to the exam would create hardship for you. You have the right to have your own physician at the examination (if you pay for the doctor yourself). If you have concerns about attending, you should talk to a workers’ comp attorney before making any decisions.
What Happens During an IME?
The IME itself usually lasts between 15 minutes and an hour. The doctor will usually review your medical records, x-rays, MRIs, etc. before meeting with you. During the exam, they may ask questions about how your injury happened, what symptoms you experience, and how your condition affects your daily life.
The physician may also perform a physical examination related to your injury. They may test your range of motion, strength, or reflexes, depending on the body part that sustained the injury. They might also order diagnostic tests, such as X-rays, MRIs, or CT scans.
After the exam ends, the doctor will write a detailed report and send it to the insurance company. If the doctor physically examined you, your employer must give you a copy of the doctor’s report within 10 business days of receiving it.
Even though the IME doctor may not be truly independent, it is always best to be honest with them.
How Can an IME Affect a Workers’ Compensation Claim?
The results of an independent medical examination can have a significant effect on your workers’ compensation benefits. If the IME doctor agrees with your treating physician, your claim may continue without interruption. However, if the IME report contradicts your doctor’s findings or recommendations, problems can arise.
The insurance company might use an unfavorable report to:
- Attempt to terminate your wage loss benefits
- Deny coverage for certain treatments
- Argue that you can return to work sooner than expected
- Claim your injury is not as severe as your doctor believes
Because the stakes are so high, preparing carefully for your IME matters. Being honest and thorough about your symptoms will provide the most accurate picture of your condition.
Do You Need a Workers’ Compensation Lawyer for an IME?
Having legal help before an IME is crucial. A workers’ comp lawyer can explain what to expect and help you prepare for the examination. They can review the IME report afterward and challenge any findings that seem unfair or inaccurate. Sometimes your lawyer might even be able to talk the adjuster out of sending you to that particular doctor for the IME.
An attorney can also ensure the insurance company follows proper procedures. If the IME results threaten your benefits, your lawyer can gather additional medical evidence to support your claim or find flaws in the IME doctor’s report to weaken their assertions. Many injured workers feel more confident knowing someone is looking out for their interests throughout this process.
Call Our Workers’ Compensation Lawyers in Raleigh, NC, to Get Legal Help
If you received an IME request or have questions about your workers’ compensation claim, Younce, Vtipil, Baznik & Banks, P.A. can help. Our legal team has over 90 years of combined legal experience handling cases for people who have sustained injuries throughout North Carolina. In particular, we have recently secured a number of significant results for injured workers, including a $2.625 million workers’ comp settlement.
Our firm cares about our clients, which is why we will give you the personal attention you deserve throughout your case. We also have staff members who are fluent in both English and Spanish ready to assist you. As one client, Russell, shared: “Very professional. They articulate things in a way you’ll understand, and show empathy and compassion for your situation.”
Let us handle communications with the insurance company so you can focus on healing. Call us today at 919-661-9000 for a free case evaluation. Our North Carolina workers’ compensation lawyers will fight for the benefits you deserve.
About the Author
Joseph R. Baznik
Joseph Baznik is an attorney at Younce, Vtipil, Baznik & Banks P.A. who specializes in workers' compensation and personal injury. Joseph speaks both English and Spanish fluently. He is licensed to practice law in the State of North Carolina and the U.S. District Court for the Western District of North Carolina.
