Independent Medical Examinations or IMEs, also referred to as Defense Medical Examinations (DME), and Insurance Medical Evaluations, are currently a mainstay of the medical-legal system.

In most cases, the examination consists of a patient interview and physical examination; psychiatric and psychological IMEs do not generally have a physical examination component.

The procedural rules governing IMEs vary across jurisdiction; however, an Independent Medical Exam is broadly defined as a health assessment conducted by a physician, not otherwise involved in the care or treatment of the individual, at the request of a third party.

The examiner is often expected to answer questions of causation, appropriateness of treatment, need for additional care, and sometimes disability, posed by the requesting party. Other issues that may arise include the presence or absence of pre-existing medical conditions, apportionment of findings, and impairment ratings. These examinations may occur in the context of a work-related injury, disability, or personal injury litigation.

If the examination is performed well, and findings and conclusions are reported in a detailed and unbiased manner, the IME may provide sufficient information to allow for settlement of a particular issue.

Alternatively, if the examination is poorly performed, so that the examinee reports that “the doctor spent five minutes with me” or the conclusions are clearly unfounded or obviously biased, the report will provide ample ammunition for opposing counsel to discredit the physician and his or her opinions.

Independent medical examinations have been referred to as Defense Medical Examinations, or DMEs, by plaintiff’s counsel, to highlight the assumption that the physician conducting the examination has a defense bias. Much of the information available on the internet, using the search term “independent medical examination” relates to educating patients about what to expect or discussing the defense bias that is assumed to be present.

It is the responsibility of the entity requesting the IME to recognize the reputation of the evaluating physician, and the risk that accompanies hiring a physician with a reputation for bias to conduct the examination. It is, of course, unrealistic to assume that there is no such thing as a work-related accident, or that every motor vehicle crash is disabling, and requesting parties may consider the physician’s “track record” when making a choice.

In the context of litigation, and most frequently in the worker’s compensation arena, independent medical examinations may be conducted to determine medical “impairment ratings.”

These ratings are performed, by definition, only when the patient’s condition has reached maximum medical improvement.

The values for impairment ratings are most commonly computed using the AMA Guides to the Evaluation of Permanent Impairment.

The ratings are often used in calculations that vary from state-to-state and at a federal level, to determine the financial compensation for a given condition.

Independent Medical Exams involve a critical analysis of all relevant medical and some non-medical information that may affect the ultimate outcome of the medical condition being evaluated. For the attorney or claims adjuster, a detailed report, including a comprehensive history (obtained from the examinee) and medical record review, will reflect the examining physician’s efforts to obtain data related to the examinee’s altered condition and the events leading up to it.

Source: “Independent Medical Examination” in Medical Legal Aspects of Medical Records, Second Edition, 2010.

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