IME – The (not so) Independent Medical Exam

There is no “i” in team, and there shouldn’t be one in “IME,” either, because there is nothing “independent” about an IME in a personal injury lawsuit. In fact, plaintiff’s’ personal injury attorneys are more properly referring to these exams as CMEs these days, or “Compulsory Medical Exams.” For purposes of this article, I will use the term “IME” only because it is more widely used, but make no mistake about it, IMEs are in no way impartial, independent or any other “i” word implying lack of bias.

What is an IME?

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So, what is an IME? In a personal injury lawsuit, an IME is a medical exam that the plaintiff must undergo at the defendant’s request, using the defendant’s choice of doctor, pursuant to discovery rules. While plaintiffs’ attorneys can have their own clients undergo an IME using a doctor of their own choice, plaintiffs really only need to be wary of the IMEs ordered by the defense (and these are the type of IME that I refer to throughout this article). Why? Because the purpose of the IME is to prepare the defendant’s expert witness — the IME doctor — to testify that you are not hurt, or that you are not hurt as badly as you say you are. Sometimes it is used to prematurely place you at MMI in an attempt to cut off your future medical care. The IME doctor knows who hired him and for what purpose, and if he ever wants to be hired by another defense attorney again (this is a lucrative repeat-business prospect) he will slant his opinions to be as unfavorable to your case as possible. Knowing this, what can you do to minimize the damage caused by an IME?

How to Handle the Exam Itself

You will receive plenty of advance notice from your own attorney when the defendant has scheduled you for an IME. You will know the name of the doctor conducting the exam and his specialty (orthopedic, neurologist, chiropractor — depending on the nature of your injury). Your attorney may know this doctor and what to expect from him, as many are repeat players that your attorney has encountered before in other lawsuits. Listen carefully to any specific advice given by your lawyer, as he will know any tricks this doctor has employed in the past. Your attorney will also let you know if someone from his office will be attending the IME (such as your lawyer himself, a paralegal or a videographer). Rules for attendance by your own side vary among jurisdictions, and different lawyers have different approaches. I will assume a worst case scenario for you — that your lawyer doesn’t know much about the doctor and that you will be attending the exam alone.

The first thing you need to realize is that you may be watched from the moment you arrive at the doctor’s office. Some IME doctors are zealous enough to watch the plaintiff as they enter the parking lot and as they leave, to see if the plaintiff lifts anything or walks differently when he doesn’t think he’s being watched. Be cognizant of your behavior in the waiting room. If you claim trouble sitting for extended periods of time, be sure that you don’t sit still in the waiting room should the doctor decide to make you wait for an hour. Take note of the exact time your actual exam with the doctor starts and ends. It will be surprisingly short in most cases (maybe even 15 minutes). Write it down. This can be later used by your attorney to cross-examine the IME doctor.

Expect that the doctor will have you fill out a questionnaire regarding your medical history and current condition. If you need to bring some notes with you to remember some of these things, do so. Describe your medical problems consistently with how you have described them to your treating doctors. If you told your treating doctor you pain is a “6 on a 10 scale,” don’t suddenly up it to a “10″ at your IME (unless you can explain what worsened your pain). Despite the fact that you filled out this questionnaire, the doctor will probably ask you many of the same questions during your physical exam. Feel free to refer him to the questionnaire if you’ve already answered the question there. Asking you the same question twice is just a way to try to catch you in an inconsistency. Also, beware of the doctor trying to conduct his own deposition of you during the exam. If he’s asking you questions about how the accident happened that do not affect your injuries (like whether the light was green or red), let him know that you don’t feel comfortable answering that question before speaking with your lawyer. Then call your lawyer and see if he wants you to answer the doctor’s question. Usually, if a doctor tries to pull these kinds of shenanigans, calling your lawyer will put an end to it. Odds are, if your deposition has already been taken in this lawsuit, the doctor has received and read it before your exam, so there’s no reason for him to need to ask those questions.

Do Not Exaggerate

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Despite the fact that the IME doctor is trying to hurt your case, do not exaggerate your symptoms in an effort to compensate for his bias. This doctor wants you to lie to him so he can call all of your injuries into question. He may even invite you to exaggerate by suggesting that certain body parts may hurt in the hopes that you’ll lie and agree with him. If your neck only hurts when you move it side to side, don’t say that it hurts when you bend it up and down as well. Certain types of injuries will lend themselves to certain painful movements, while not causing pain with others. For example, a shoulder injury may cause it to be painful to lift something with your arm extended in front you, but not cause pain when you lift something with your arm at your side. Describe the pain as it is, not as you think it should be or as the doctor suggests it should be. That being said, if the doctor does something which causes you pain, be sure to let him know even if he doesn’t ask. Otherwise, he will assume that your silence means “no pain.”

Settlement tip

Do Not Socialize

If this doctor is clever, he will probably be nice to you and try to get you into a talkative mood. Be polite, but don’t treat this meeting as a social conversation. The IME doctor doesn’t need to know that your kids play in little league or that you hate your job. Keep reminding yourself why you are there and assume that anything you volunteer outside of medical information will come back to haunt you. This is not your treating doctor. Everything you tell him will be relayed to the defense attorney.

Occasionally, I have seen IME doctors try to have plaintiffs fill out “exit interview” or “feedback” questionnaires which ask for your feelings about the medical exam. Do not fill this out. Politely decline and leave. The last thing you want is your positive review of this doctor’s exam being used against you in court. If you give him a negative review, he may characterize you as hostile and imply that you were not forthcoming during the exam because you didn’t like him. These types of exit interview forms are a no-win proposition — so it is best that you don’t fill them out at all.

The IME Report

After every IME, the doctor will generate a written report of his findings, which your attorney will receive within a month or so after the exam. Ask your attorney to let you see the report when he gets it, and note any inaccuracies in the report. Make sure the IME doctor did not put any words in your mouth. Note any complaints you made to the doctor which are not reflected in the report. Expect that the doctor will minimize your injuries as much as possible. He may even claim that your injuries are unrelated to your accident. This is typical, and there is nothing you can do about it. You are mainly concerned with the facts, not his opinions. Your lawyer will address the doctor’s opinions when the time comes.

Psychiatric or Psychological IMEs

As a final word on IMEs, know that IMEs for psychiatric or psychological issues (in cases where you have significant emotional distress injuries, such as PTSD) can be quite different from IMEs for physical issues. They will usually be much longer, and will likely involve extensive written testing (there are standardized psychological tests, such as the MMPI, which can take hours to complete). Sometimes these types of exams can be split over more than one day, with one day for written testing and another for oral interviews. There are usually greater restrictions on your ability to bring someone with you to the exam, such as your lawyer. When your attorney gets notice of a “Psych IME” it should list all of the proposed tests. If you have unusual anxiety about this exam, discuss it with your mental health care professional and your lawyer, and see if there are accommodations which can make you more comfortable, such as shorter exam sessions spread out over more days.

As with physical IMEs, don’t try to help your case by exaggerating your symptoms. Be honest, but always keep in mind that this is not your treating mental health care provider examining you. They are not examining you for treatment purposes, but rather to hurt your lawsuit.

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44 Responses to IME – The (not so) Independent Medical Exam

  1. I am going for an IME- my problem is I smoke pot. This problem is for my hip I’m 57 and I took a drug screen in the initial Injury. I still have the paper work. Do you think they will drug screen me again. and if they do, do you think it will be an observed screening?

    • fl_litig8r says:

      If this is for a personal injury lawsuit, the notice your lawyer received setting the IME would have to include the types of tests to be done, especially something as invasive as an observed urine test. If it doesn’t say what kinds of tests are to be done, tell your lawyer about the pot (really, he can’t dime you out), so he knows to require more specificity in the IME notice. Then, if the test isn’t listed, they can’t do it (at least not at THIS IME).

      If this is worker’s comp, this really isn’t my area of expertise. However, a good way to find out if you’re going to be in trouble is to buy a home test from pharmacy and test yourself. Find one that triggers at 50ng/mL for cannabinoids. This is a fairly standard level for most professional tests, as lower levels result in more false positives.

      Obviously, you should stop smoking immediately, as the longer you go without smoking before the IME, the better your chances are of getting a negative result.

      If you didn’t use a fake name for this message (you should have), let me know ASAP so I can change it. Email me at fl_litig8rATidonotwanttobeyourlawyerDOTcom (change the “AT” and and “DOT”). The last thing you want is someone finding this through Google.

  2. michaela salinas says:

    I am being asked to attend at the request of worksmans comp to go to an IME what should i look out for

    • fl_litig8r says:

      Disclaimer: I am not a workers’ comp attorney. That being said, there are too many tricks IME doctors have to make a comprehensive list. Generally, assume that you are being watched the whole time you are at the exam, from the parking lot to the waiting room and up until you leave. Don’t say something hurts if it doesn’t. The doctor may be testing you to see if you’re exaggerating your symptoms (by doing something he knows won’t hurt). If your neck is injured, he may move around the room while talking to you to see if you turn your neck to follow him. He could try to distract you with one test while really trying to see if another part of your body hurts (e.g., he could move your arm and see if you turn your head without pain to see what he’s doing).

      Basically, don’t lie and don’t try to help your case by exaggerating. You don’t want to give the doctor any ammunition to claim that you are a malingerer or that you magnify your symptoms.

  3. Mariana says:

    I went to an IME for a car accident I had. However, today I received a copy of the report and it made me furious to see that the doctor said I was exagerating my symptoms. It is definitely not true, I have a herniated disk and also bulging disks, all on my neck which cause me a lot of pain. Does this happen a lot, where the independent doctor says a patient is exagerating their symptoms and what can my attorney do about it? Oh yeah, now after this report, the insurance company is saying they will not pay for any more treatment.

    • fl_litig8r says:

      It is extremely common for IME doctors to claim symptom exaggeration. Don’t take it personally. Your attorney can’t do anything about what is written in the report, but he can depose the IME doctor to dispute the basis for his opinions, as well as expose his biases (does he mainly do defense work, how often does he claim symptom exaggeration, how much he was paid for his opinion, etc.). Also, your treating doctors will presumably disagree with the claim of symptom exaggeration. It then becomes a matter of credibility, between (1) you and your treating doctors and (2) the IME doctor.

  4. Ruben says:

    I had a thumb injury 2-3 months ago, and I got workers comp. i’m almost done with therapy, am i going to get a dissability or settlement afterward?

    • fl_litig8r says:

      Disclaimer: I’m not a worker’s comp lawyer and worker’s comp laws vary from state to state.
      Whether you get a disability settlement from your thumb injury will almost surely depend on whether your injury qualifies as a permanent partial disability. Most states have lists of certain injuries that automatically qualify as such, with a scheduled monetary award (usually put in terms of “X number of weeks pay” based on your prior earnings) for each type of injury. A loss of a finger is usually on the list, but an injury to a finger probably won’t be.

      Even though your injury may not be on the list, it may still qualify as a permanent partial disability, depending on its severity. However, unlisted injuries are often contentious, so you’d be wise to consult a worker’s comp lawyer in your state (they usually offer free consultations). You may also want to read this article I found, which gives a good overview of permanent partial disability in worker’s compensation cases nationwide.

  5. DPMS says:

    I see that most, if not all IME Physicians fall in line with the insurance companies as far as the evaluation goes, But if the IME physicians have medical evidence in front of them such as Cat scans, MRI’S, X-rays along with other prior medical records from general physicians that shows no prior injuries and the IME Physicians still give a inept report/ opinion against the person receiving the IME does this put the physicians in a liability stance for a inept report because they are using there medical opinion that will effect future medical care of the person that was injured.

    • fl_litig8r says:

      Usually, no. It is generally understood that IME doctors do not establish a doctor-patient relationship with the people they evaluate (most will have you sign a form stating this). However, there is one case from Arizona of which I am aware in which an IME doctor was held liable for medical malpractice for an IME he performed in a workers compensation case. The appellate court, upholding a large judgment against the IME doctor, held in part that because the doctor had agreed to evaluate the claimant and make treatment recommendations, he could be liable despite the claimant signing a disclaimer form stating that no physician-patient relationship was established. This appellate court ruling was from 2009, and according to other websites it was appealed to the Arizona Supreme Court. My own research into that appeal showed no disposition by the Arizona Supreme Court, and the case is not currently pending, so I can only assume that it settled.

      This Arizona case appears to be an anomaly, so don’t get your hopes up about a flood of lawsuits against IME doctors. It is good to know, though, that at least some judges are willing to entertain the thought that an IME doctor who causes your treatment to be cut off could be liable for medical malpractice when his medical evaluation falls below the applicable standard of care.

  6. Boots says:

    Can IMEs include a surgery? Can the defense ask u to have an invasive procedure?

    • fl_litig8r says:

      I’ve never heard of an IME requesting surgical exploration or similar invasive testing. While some crazy defense lawyer may try to ask for this, no reasonable judge would allow such a thing, given the risks to the plaintiff. If a defendant were to request such a thing, your lawyer’s immediate response would be to ask the court for a “protective order” which would limit any IME to non-invasive examination and testing.

      I really can’t imagine any IME doctor wanting to expose himself to liability for any harm that may result from such a test, so I doubt that you have to worry about this even being suggested.

  7. Sharon Stoneseifer says:

    What if my Attorney does not offer a staff member to attend my IME? Should I bring a friend/nurse? I am 2 hours away from my Attorney’s office.
    Can I ask to see the plaintiff’s answers to the interrogatories that my Attorney sent her (when they are completed) and the reply to the complaint? I don’t want to be insulting.

    • fl_litig8r says:

      It would be pretty difficult to get anyone who is not part of the litigation into the IME. Some defense attorneys even raise objections to the plaintiff’s attorneys or paralegals (or videographers) attending — who is allowed into an IME will vary by state, and can change over time. You’d need to bounce this off of your lawyer first — don’t just show up at the IME with a third party. Your lawyer is going to be the one who argues this issue before a judge, so let him make the call as to whether it’s important enough to fight for.

      As to your interrogatory answers, any plaintiff that doesn’t insist on seeing the final answers before they go out is asking for trouble. You are the one signing these answers under oath. A lot of attorneys will have clients sign the oath at the end of the interrogatories before the final answers are prepared, which is fine (for logistical purposes) as long as the client sees and has final approval over the answers. Definitely have him e-mail or fax the final answers to you before they go out.

      Most lawyers won’t take offense at clients asking for a copy of the defendant’s Answer to the Complaint (a Reply is what a Plaintiff files in response to an Answer — and they are not often needed). Just don’t expect anything particularly enlightening. Many will just be blanket denials of almost every allegation, followed by boilerplate affirmative defenses which may or may not even apply in your case. So, don’t freak out if the Defendant alleges comparative negligence as a defense, even in cases where the other driver is clearly at fault. Any affirmative defense the defendant doesn’t include is deemed waived, so they tend to include them all. Later, if any defenses get stricken because they are unsupported by the evidence, the defense attorney doesn’t care. However, if he fails to raise one which later appears to be viable, he may have committed malpractice. Expect the kitchen sink.

  8. John Doe says:

    I recentally had an IME appointment and the doctor gave me a joke of an exam. He concluded i was 50% disabled and that he believes i can return to work with 20 pound weight limit and the need to sit and stand throughour my shift. The specialist whom is going to be performing surgery has me at 100% disability for two different appointments. One prior and one after my IME exam. Comp is now paying me at a rate of 50% and will not change it untill i have surgery performed on me.n I also have my refering doctor whom wrote me off at 75% disability. Can i make comp pay me at the 100% prior to my surgery. Thank you for your time.

    • fl_litig8r says:

      If you haven’t already, you should seriously consider hiring a workers comp lawyer. When the employer’s IME disputes your treating doctor’s disability opinion, the only way to try to force the employer/carrier to accept your doctor’s opinion is through litigation. I don’t know how long it will take for the disability issue to be resolved, but you should start fighting it now, as I would expect their IME doctor to give you a less favorable disability opinion than your treating doctors even after your surgery.

  9. Jacey says:

    I just had an IME for a car accident I was involved with. The accident was not my fault and I have been in treatment for 3 years. I was getting physical therapy for my lower back which resulted in a surgery after the accident had exacerbated the problem. My attorney sent me a letter to inform me of this IME. It was not an IME to determine if I should get more treatment it was for the intention of a settlement. I was advised not to volunteer information about who was at fault for the accident but when the IME doctor asked how the accident occurred I told him – I now fear that I should not have. Also, I said that I had a back problem for which I was going to therapy for and the accident occurred right after a treatment. I feel I should not have said that either. I can’t sleep now thinking of this. I have serious injuries and wanted to know -doesn’t the IME know of the whole case? I assume he would have know everything I told him but after I said I had a prior problem with my lower back but that it was exacerbated by the accident and resulted in surgery he then asked me if I had surgery on my neck -which I did not have prior problems with but now have many herniated disks he ended the exam. Does the IME know of the case details or did I say to much? It is so hard to know what to answer and what not answer. It would seem to me he would know all the details. I feel very nervous and now think I will never be compensated for all the problems this accident has caused me over the last three years and most likely for the rest of my life. I also said I was afraid to have surgery on my neck due to the fact that I had developed a staph infection after the lower back surgery and was bedridden for 3 months. Sorry this was so long – any advice would be appreciated.

    Just wanted to add one more thing. I also told the IME that I was off pain killers – which I was on for 3 years and I try no to take anything to kill the pain. I informed him that I take Aleve and at the time of the exam I did not take any that day. I left out so many things that this pain has affected in my life. Like poor quality of sleep, the fact that I work for my family business from home – and very little – not like a real job. I was wondering if I could ask to have another IME – I am sure I cannot but I felt very uneasy and nervous during this exam. It all seems very unfair. What can I do to get a fair assessment. I wish my attorney had told me more about this. I did not feel it was a big deal until I got there and went through it. I was very rushed – the whole exam took about 10 minutes. Thank you for your time and the great advise I have seen on your site – just wish I had found it before I went to the exam.

    • fl_litig8r says:

      Don’t worry about what you told the IME doctor. If he didn’t already have your prior medical records before the IME, he will definitely get them before filling out his report — it’s far better that you admitted to the prior injury rather than trying to hide it. He would have found out anyway.

      As far as how the accident happened, as long as your description to him was consistent with what you have said and/or will say in your lawsuit about how it happened, it shouldn’t create any problems. Plaintiffs’ lawyers don’t like IME doctors asking these types of questions because it creates an additional opportunity for inconsistency, and frequently the doctors don’t need this information to evaluate your injuries — they just like playing detective.

      You definitely don’t want another IME. Rest assured that no matter how much or how little you said in this IME, the doctor would have written a report designed to hurt your case — that’s what he’s being paid for. Your own treating doctors will dispute his opinions, and hopefully their opinions will carry more weight with a jury (if it gets that far) than the opinion of a man who examined you for 10 minutes (which is typical in IMEs).

      While it sucks that plaintiffs have to endure this type of charade (that an IME doctor would ever give you a fair shake), it’s a known part of litigation that most lawyers and adjusters don’t put a whole lot of stock in (privately, at least). Just feel better that it is over with, and know that nothing you could have done would have won that doctor over or made him write a report that was favorable to your case.

  10. Jacey says:

    Wow! Thanks so much for your response. I truly appreciate your website – I have been reading it most of today! I also purchased your $10.00 tip. I used a different email address that is attached to my pay-pal account but have not received anything as of yet. I did want to contribute to your site in some way to thank you and also hoping the tip can help me if the opportunity presents itself! You are truly very kind to ease my mind – perhaps I can sleep tonight and catch up on what I lost last night! Thanks again!

    • fl_litig8r says:

      I sent a copy of the tip to the e-mail address you listed in this comment just in case something went wrong with the e-mail containing the download link that was sent to your other address (maybe a spam folder ate it).

  11. abreezy says:

    i was in a car accident about a year ago, and i am still having severe back pain. i had my ime done about a month ago and got a letter from my car insurance company saying no further medical treatment will be covered. can they do that if im still in alot of pain? (iv had physical therapy back cream medicatons epidural injections-4 and trigger point injections-3)

    • fl_litig8r says:

      If this is in relation to a no-fault claim (PIP), it is pretty common for insurers to cut off their own insureds from treatment after an IME. If you still have coverage remaining, you really should call a local lawyer who handles PIP cases to see if it’s worth suing over. Because all no-fault states that I know of allow attorneys to recover their fees if they succeed on a plaintiff’s no-fault claim, lawyers have an incentive to take your case even if the cost of the treatment denied is low (people have sued over $100.00 treatments and their lawyers have gotten thousand for winning). The sooner you call someone, the better.

  12. SandyLee says:

    My situation is I was hurt at work, a back injury was on TTD payments, they set me up to see a Doctor so went, he sent me to therapy for 2 weeks came back, and then informed me he would write his summary, said you will be compensated, and good luck and TTD checks stopped. I was never informed this was a IME, was just told it was a Doctor appointment to see if he could help my condition. Is this normal for them to do to people to get them off TTD? I have since sought my own treatment with other Doctors who all have said I have a problem and need treatment, as I am not better, so I do not understand how this one doctor who seen me for a whole 10 minutes was able to write me off.

    • fl_litig8r says:

      IME doctors know who writes their checks. Many of them rely on repeat business, so if they don’t routinely opine that workers are at MMI and ready to return to full duty work, the employer/carrier will find another doctor to send its business. The 10-minute quickie evaluation is pretty standard — the IME doctor will probably say that he relied largely on your prior medical records if asked how he could reach his conclusion so quickly.

      If your regular treating doctors don’t agree with the IME doctor’s assessment, you should call a worker’s compensation lawyer ASAP to discuss whether it is worth disputing the IME doctor’s findings.

  13. JenJ says:

    I was asked to see an IME doctor as a formality. My MRIs are very compelling evidence of my back problems, but I have no orthopedist surgeon consult in my medical files because my doctor is moving in a different direction to treat my issue. I can provide you the actual language in the MRI if it would help.

    The IME doctor astounded both my employer and me by saying I was not substantially incapacitated. In addition, he blatantly lied — he could not align his opinion with the factual evidence of the X-rays and MRI, so he lied,and said he did not have access to this material. He actually references this materials he says he doesn’t have, elsewhere in his report.

    My employer is demanding a supplemental IME report from him. They’ve asked him to reference the factual material in his conclusion, and explain any deviations between his opinion and the factual evidence. Both my employer and I believe that he will lie again in trying to justify his response.

    Some people I have talked to believe that my employer is not as astonished as they are appearing. I am not naïve, but I do not believe this is the case for a number for reasons I can’t go into here.

    My question is: why would this hack doctor do such a thing? I don’t get it. I know my employer didn’t plan it — I was originally scheduled to see another doctor, and had to reschedule a day later due to time conflicts — or even expect this response from the doctor. So, why would he do it? What is his motive? And what can I do to protect myself from morally repugnant hacks like him?

    Obviously, I have no attorney — this has not been a contentious process, except for the that that the staff who was supposed to be working on my case sat on it for months, and now her manager is having to deal with it. Do I need an attorney?

    • fl_litig8r says:

      Unless your employer is self-insured, there is also an insurance carrier involved who the IME doctor may be aiming to please. Even if it’s just the employer, the IME doctor may have just assumed that it wanted a report for the purpose of denying benefits (a safe assumption in most cases). While you could wait to see if the revised report requested by your employer changes his opinions significantly, I would still suggest at least consulting a workers compensation lawyer now just to see if he thinks that there is anything he can do for you right now.

  14. JenJ says:

    My employer is self-insured. They are trying to help me get qualified through my serious internal problems, as well. They are taking a two pronged approach to this because they, like me, do not believe hack doctor is going to admit that he lied. They are really working with me on this, because there is no doubt in their minds that I am truly unable to work.

    Also, they have no dog in this fight. I am eligible for regular retirement. I don’t get any more money or any additional benefits with a disability retirement than I do with regular retirement.

    The only difference is that disability retirement preserves a position for me — I must be placed in an equivalent position once my doctor releases me to work. This is critical because I cannot live on the retirement alone, and I know I will be virtually unemployable if I try to return without reinstatement rights — a woman in her early-mid fifties with a history of serious health issues? Forget it.

    That is the only reason I am fighting so hard for disability retirement. I don’t even want to retire! If there were any way to keep working, I would be there doing it. That’s why this doctor’s report comes as such a shock.

    But my disability people are right that my primary, who is an internist, should be qualifying me as disabled based on an assortment of incapacitating internal issues. They are puzzled as to why she wouldn’t simply qualify me based on her area of expertise. I get that the MRI is so compelling, that my doctor figured that would be the quickest and easiest way to go, but I also understand why it might appear confusing to the Disability folks that my primary is trying to qualify me for disability in an area of specialty that she is not an expert in.

    The disability manager told me, before I ever saw the IME doctor, that she could approve my application if my doctor even had any notes in the file regarding problems controlling my blood sugars, and neurological issues. She even explained what neurological issues would be most compelling.

    I, however, got up on my moral high horse and rode away from that suggestion– how dare she tell my doctor what to do? I didn’t know then that the IME doctor would have zero moral qualms when it came to compromising his own personal integrity for no apparent reason. Lying about factual issues!

    No matter how this turns out, I plan on filing a complaint with the medical review board against him. I have no expectation it will do anything other than start a badly needed paper trail against him.

    He has so many horrible online reveiws! Even for an IME doctor, complaints against him are off the charts (no pun intended). And the complaints are consistent — there are two specific complaints about him, and one of them is that he makes a snap decision as soon as he sees a client, and then tries to twists the evidence — labs, x-rays, MRIs, etc — to meet his own personal opinion. I would never have agreed to see him if I had done any the slightest bit of online research first.

    I see my primary on Wednesday. I desperately need her to advocate aggressively on my behalf at this point, and make sure that I am approved due to internal issues. I hope she will. Otherwise, it is appeals for me, which will take years to work through the system. I will be destitute by the time that happens.

    Any other advice you might be able to offer will be so greatly appreciated.

    • fl_litig8r says:

      You seem to already know the deal, so there’s not a lot I can add. It really sounds like this IME doctor is just a paid shill who doesn’t even know when the E/C doesn’t want him to screw the employee over. Is your employer using a third party company to handle the claim, or does it do this in house? If it’s in house, they might be able to just disregard the IME doctor’s clearly biased and unsubstantiated opinion and approve your claim in spite of his report. While I’m no workers comp expert, I can’t imagine that his report is necessary to them approving your claim if they make the claims decisions in house.

      From now on, when your disability manager gives you hints on how to get your claim approved, use them. You’ve seen how the game is rigged for the other side, so I see no problem rigging it in your favor when you believe that you have a bona fide claim.

  15. JenJ says:

    My doctor filled out all the paperwork requested of her for my employer to approve my application. Now they are asking for another IME. They are looking to decline it on the internal basis. I have a multitude of internal issues — diabetes, uncontrolled hypertension for five years, hypothyroidism, asthma, etc. The problem is that the medication I take for my back pain (120 mg of oxycodone per day plus muscle relaxers) “masks” the symptoms of any complications from the internal issues as well.

    What is an IME internist even going to look for? Should I be worried about them surveilling me? Why won’t they get a second opinion on the back issue when there is such a discrepancy between the doctor who says I am completely disabled, and the doctor who says there is nothing disabling about my back at all?

    The manager says that they have the ability to override an IME doctor’s opinion in favor of my doctor’s word, whereas they didn’t have that choice with the back issue because my doctor wasn’t an orthopedic specialist. I asked why they’d even send me to a IME doctor if they were going to ignore it in favor of my doctor’s statement. I said it sounded to me that they were looking to decline the IME. The manager didn’t disagree but reiterated that she continued to believe that I was disabled and that she would continue to advocate on my behalf.

    My question is how much crap do I go through before it sinks it that she is playing me for an absolute sucker?

    please don’t print this, but my insurance is [Removed by Admin]. I feel like I’ve been set up since day one and my only hope is to get this to an appeals judge. What do you think?

    Also, what exactly is an IME internist looking for? What do they consider ‘disabling?”

    One last thing. The last few times [Removed by Admin], the disability manager has called with really bad news, she waits until right after 5 pm on Friday to call me. Never fails. Between 5:10 and 5:30 pm Friday. Then she commiserates with me the whole time she’s on the phone about how she’s doing everything she can to help, so that I am apologizing to HER by the end of the call, and I don’t ever make that call to the attorney that maybe I should.

    I also suspect I was under surveillance last week — don’t want to go into it, found out TOTALLY by accident (it seemed pretty cut and dried), and thought I was being paranoid. I’m not so sure now.

    • fl_litig8r says:

      As far as the back condition is concerned, I would be concerned if the IME doctor is an orthopedic specialist and your treating doctor is not. If possible, I would try to get a referral to an ortho doc from the primary doc to hopefully back up your primary’s doc’s opinion about your back.

      It sounds like the second IME is intended to provide a different specialist to dispute your non-orthopedic conditions, so you are probably right to assume that this adjuster is not doing you any favors. If you haven’t already, I’d consult with a workers comp attorney as soon as possible so that you can take steps to shore up your case before the next IME. I wouldn’t wait until you get denied and hope you can win on appeal, as there may be issues in trying to submit new evidence of disability after the initial denial — there may not (again, workers comp isn’t my bag), but I think the safest route is to have all of your evidence submitted before the initial denial.

      With respect to surveillance, it’s always a possibility in workers comp or other disability cases. There’s not a whole lot you can do about it, aside from not pushing yourself when out in public. People get into trouble especially when on pain medication, doing things which don’t hurt due to the drugs, but paying the price for them the following day (or when the drugs start to wear off). The cameras are only going to see you performing exertional activities outside. They won’t see you lying in pain on the couch the next day. While you should never try to “act” for the cameras, you should limit your public activities to things you think you could do if you weren’t on pain medication. If your doctor has placed limitations on your lifting, standing, walking and sitting, keep those in mind when out and about.

      The question of what constitutes a disabling condition will vary based on your job duties (and other jobs your employer may be able to transfer you to with lower exertional requirements). There are 5 basic exertional categories for jobs: sedentary, light, medium, heavy and very heavy. A general description of the physical requirements for these categories can be found here, which discusses their use in the Social Security disability context. There are more specific descriptions for each category that break down lifting requirements and sitting, standing and walking requirements, (a good description can be found here, under the Glossary section “Exertional Level”) but this should be a good start for applying them in a workers comp context.

      Your exertional abilities are much easier to measure for muscle, skeletal or nerve injuries, such as your back problem. They are more nuanced and variable when it comes to systemic ailments like diabetes, hypertension and asthma — as you can imagine, asking yourself how many pounds a person with asthma can lift seems like a crazy question. These ailments don’t really lend themselves to hard and fast numbers (as a far as lifting or standing) which can be compared to standard exertional levels, so doctors have a good deal of discretion in opining whether your conditions are disabling. Obviously, the worse the conditions are and the harder they are to control from a medical standpoint come into play. For example, a diabetic who can control her diabetes through diet alone would have a harder time proving disability than one who requires insulin. A more specific analysis of how your ailments affect your ability to perform your specific job is required, given the environmental conditions of our job and how your job has affected your ability to manage these ailments in the past.

      In short, while systemic problems may make it easier for your treating doctor to say that your disabled, they also make it easier for an IME doctor say you are not disabled. The effects of your job on these conditions is inherently less predictable than the effects of a more easily quantified condition, like your back injury. A history of you job negatively affecting these chronic conditions would be extremely helpful in proving disability. If I were a lawyer trying to prove disability in your case, I’d much rather have the back injury as the primary disabling condition, assuming the MRIs show a bad enough condition — which is why I think that finding a specialist to back up your primary doctor is important. I’d really start calling workers comp lawyers on Monday morning if I were you. Just waiting to see what the E/C does at this point isn’t a wise strategy.

  16. JenJ says:

    Thank you so much. Yes, I already have a list of attorneys to start calling on Monday. I also already have an appointment with an orthopedic specialist next month — -my doctor made the appointment as soon as this IME doctor came in with the crazy diagnosis. The reason I didn’t see an orthopedist before was because I was seeing a pain specialist. My doctor and the Pain doctor knew there were bad problems with my back, but I don’t think anyone knew how bad they really were until earlier this year.

    For some reason, I have a history of doctors not believing me when I try to tell to tell them that I am in horrible pain. Probably, because it’s just not in my nature to cause a big fuss about it. In the last eighteen months alone, I’ve 1) gone to work with two fractured ribs because my former primary physician just didn’t believe I could have fractured my ribs falling into my dining room table (which I did, and which X-rays revealed — two very bad fractures! – once I finaly got the x-rays), and 2) gone to work for two months in utter ongoing abdominal pain that I thought really was going to kill me. My new primary, at that time, sent me to a psychiatrist! I begged the physiatrist to look at my chart to see if he could find out was wrong, but he wouldn’t. Another doctor’s assistant found-by accident!-an ultrasound from a year previous showing multiple gallstones and sludge in my gallbladder. They rushed me into surgery and took my gall bladder out at the same time they removed a huge lipoma across my back.

    I believe it was the surgeon hacking away at the lipoma on my back that caused my current back conditions, although I realize I’ll never be able to prove it. Prior to that surgery I only had osteoarthritis in my lower back.

    At any rate, I fussed enough about the back pain that pretty disabled me completely until they finally did the MRI in January. Once they got the MRI results, they kind of freaked out. My pain doc explained she couldn’t give me cortisone injections that might help because that is are contraindicated by my diabetes. She wanted to to put me on morphine or methadone, and when I refused, she just said my primary doc would have to treat it. Then my back began spasming up. I tried so hard to avoid taking hard opiates, but by then I just didn’t care what it took to get rid of the pain. I will also add that the urgent care doctors I see, take one look at that MRI and immediately, IMMEDIATELY, offer me injections of dilaudid. Without fail. I was quite surprised to learn that this is not standard operating procedure, in fact.

    All this by way of explaining why my doctor wasn’t at all concerned about an orthopedic specialist reviewing my back. She just said to make sure he saw the MRI (which he tried to lie about as you may remember). Even [Name removed by Admin] said that, in her experience, the MRI was a pretty strong indicator that there was significant disability going on. Of course, it’s terribly hard to know what [Name removed by Admin] game is right at the moment.

    Anyway, thank you again for listening and advising. This has been a nightmare. I should have listened to my instincts and gotten an attorney as soon as the orthopedic IME specialist out and out lied about my back and about not having materials he referenced elsewhere in the report. In retrospect, I feel as if Wendy has played me like a yo-yo on this issue.

  17. kim says:

    what happen after a positive ime report for a personal injury claim
    doctor agree that I need more treatment and agree with my doctors does this help with my settlement

    • fl_litig8r says:

      It certainly doesn’t hurt. Whether your case will settle or not depends on many other factors aside from your need for future medical care, however. There could be issues of causation, liability (fault), value of economic and non-economic damages and several others which could preclude or delay a settlement, so while a favorable IME report is always a good thing, it isn’t the “be all, end all” of settlement issues.

  18. Michelle says:

    In a workmen’s comp case, can the insurance company choose an IME doctor that is affiliated with the hospital where the injury occurred? The hospital is named in the suit.

    • fl_litig8r says:

      Well, “affiliated” is kind of a broad term. Lots of doctors have privileges at local hospitals — that doesn’t mean that they’re the hospital’s employees. If that’s the type of affiliation you’re talking about, I doubt there would be any legal problem with it. Of course, if he writes a bad report, your lawyer can always try to impeach him due to bias based on his affiliation with the hospital.

      Just know that when it comes to IMEs, the fact that this doctor is being paid by the E/C will influence his opinion far more than any outside relationship with the hospital at issue might. IME doctors overwhelmingly tend to give opinions that favor whoever is paying for the IME to ensure repeat business. Any IME doctor the E/C hires is likely going to write a damaging (to you) opinion. This hospital affiliation is probably not going to make it any worse than it already would have been — and, as I said, it may help you impeach the doctor.

  19. Ruth says:

    My insurance adjuster asked me to attend an I.M.E., which I did. When the adjuster received the report and recommendations, he was not agreement. Since then, the adjuster has been trying to contact the doctor in question to request that he change his recommendations. It certainly seems unethical, but would it be legal to change the report based on the urges of an insurance company? Since my appointment with this doctor, I have received a positive (objective) diagnosis for another disease….which I am certain the adjuster with not disclose to the doctor.

    • fl_litig8r says:

      It’s legal insofar as the adjuster will likely not tell the doctor outright to change his report. Instead, he’ll “ask questions” designed to let the doctor know what the insurer wants to appear in the report, and see if the pressure gets him to change it. It’s obviously underhanded and wrong, but it’s something that happens (though it doesn’t need to occur that often because most doctors hired for IMEs know what the insurers want and give it to them in the first place). On the plus side, if the IME doctor does change his report, this provides you with some wonderful ammunition to attack his new findings through litigation.

      In short, if the doctor changes the report, you should contact a lawyer (if you don’t already have one).

      As to the new diagnosis, that may or may not be relevant to the IME doctor’s report. Often, IMEs are rendered by a specialist in a particular field solely for the condition that falls within their area of study. So, if you received an IME from an orthopedist for a knee problem, he would probably limit his analysis to how the knee limits you, rather than consider other conditions, like heart disease or diabetes, which may also affect you. It’s not uncommon to get multiple IMEs from different specialists for each medical condition that affects your ability to function.

  20. Ruth says:

    This is helpful, thank you. The new diagnosis has everything to do with my current situation, it is a test the actual I.M.E. doctor recommended. That being said, I have taken the liberty of faxing the I.M.E. doctor the results, should the insurance adjuster attempt to contact him. I do not have a lawyer at this time. But I will certainly be retaining one if the I.M.E. report changes.

    • fl_litig8r says:

      Good for you in taking the initiative to fax the new records to the IME doctor. Hang on to the confirmation page from that fax so you can prove that the doctor received those records should it later become an issue.

  21. Paul says:

    I went for an IME last week, after speaking to me for a couple minutes, wiggling my leg, the dr got up and readied to leave, i asked him if he was done, and he said.. “Yes. doesn’t take long on these”.
    When i asked him a couple more questions, it was concluded he couldnt have the conversation with me, said some other things… How often does an IME dr, tell plaintiff, you’re not going back to work with that knee, and be lieing?

    • fl_litig8r says:

      Most of the time, IME doctors don’t tell the claimant their prognosis. They aren’t treating doctors, so they usually don’t offer any opinions at all directly to the claimant. In your case, if the doctor told you that he doesn’t think you can work due to your knee, I’d be cautiously optimistic. It would be awkward for him to tell you one thing and write something else in his report (though that does occasionally happen), but if it does happen, you have some good ammunition to take to a lawyer.

  22. Jesse the body says:

    I need some advice on how to talk to my lawyer. I have 2 focal protrusion discs i think on the L-5 and T-1..
    in anycase I have gotten an IME and denied. of course. She lied about what I said completely saying that I said that Choiro and massage was not helping at all. in fact made it worse she claims. I submitted a letter stating it was a bold and gross mis interpretation of what I said and then stated what I said in the letter. In anycase, my lawyer sat on his thumbs and did nothing to battle it. He said once the IME denies you, you won get it back. So he suggest PT and I go til the release me. then a month later the pain came back and now they are saying injections or operation. However like 5 doctor of mine say that I just need Chirio and massage. But oh look its been denied… My lawyer still sitting on his thumbs but I complain and say “cant we fight this?” I have 5 doctors saying that I need this and Yet 1 doctor is in my way for treatment? I get 3-5 days relief from chiro but since Ive been off it my back is screaming. What makes me mad is I had to find out i could rebutle with more than a letter from me countering her statments. He should have had the IME sent to my Chrio, Primary, ortho, and a 3rd opinion chrio. AND to send out refferals from Doctors, DR. notes and my freakin letter. but noooooo i had to think of it and all but force the issue. i am very unhappy with his performance. what do I do?

    • fl_litig8r says:

      I think you may have fallen victim to the dim view of chiropractic care held by both the insurance and legal communities. Many lawyers feel that chiropractic care is at best a stop-gap measure to provide temporary relief while the client either recovers naturally or finds a real medical solution. Insurers probably don’t even give it that much credit. This view would be consistent with your lawyer’s unwillingness to fight for continued chiropractic care, as he probably feels that continuing to provide chiropractic care on an indefinite basis as a temporary pain-relief solution is not something that the insurer and court would approve because it does not lead to an eventual recovery — and that’s likely a position he feels is reasonable.

      I’m really on the fence myself when it comes to chiropractic care, so I can see where he’s coming from. However, when it comes to back pain, surgery often provides little relief. It will often fix issues with numbness or weakness in the extremities, but still leave the pain. So, for people who have back pain, but no numbness or weakness in the limbs, it’s difficult to promote surgery as a remedy, either. This leaves people with back pain three alternatives — (1) endure the pain, (2) take narcotic pain medication and (3) chiropractic care. Out of those options, chiropractic care is the best, as long as the patient actually receives pain relief from the treatment. Unfortunately, it’s more expensive to provide than option #2, so you’ll see insurers pushing people toward that solution, regardless of the long-term health consequence that can result from taking narcotic pain medications over a long period of time — the most frequent consequence being addiction.

      This was a bit long-winded, but I’m trying to give you a reference point from which to discuss this issue with your lawyer. I think a face-to-face meeting, where you discuss why continuing chiropractic care is the best solution for you, as opposed to surgery or pain meds, might help bring him around and encourage him to fight more for continued care. Be warned, though, that even if you sell your lawyer on chiro care, he may not be able to sell it to the insurer or judge. One of the biggest hurdles you face is the question of how long should the insurer be required to pay for chiropractic care. For life? That’s an expensive proposition for a relatively expensive treatment that only provides palliative care. Your lawyer may be convinced that such an argument has no chance of winning (and he may be right), but the best you can do is try to remove any personal bias he has against chiro care when he’s making that assessment.

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