The Independent Medical Examination
- Talk To Your Lawyer
- Not Medical Treatment
- What the Doctor Looks For
- Don’t Expect A Fair Report
When a plaintiff in personal injury litigation puts an aspect of his or her physical or mental health into issue, such as by claiming to suffer disability from a back injury, or claiming to suffer emotional distress and depression as a result of an accident, the defense will seek evidence to challenge the claimed damages or disability. In personal injury and workers’ compensation cases, the defense will often seek to do this by obtaining what is commonly deemed an “IME” or “Independent Medical Examination”. Within this context, a more accurate name would be “Defense Medical Examination” or “Adverse Medical Examination”.
Sometimes, when more than one aspect of a plaintiff’s health are at issue, the plaintiff may have to undergo more than one IME. For example, if the plaintiff is being treated by a neurologist, orthopedic surgeon, and an expert in physical medicine and rehabilitation, the defense may seek IME’s performed by its own specialists in each of those fields.
When the plaintiff is represented by counsel, the IME will often be scheduled by agreement of the parties. Otherwise, the defense is likely to seek a court order requiring the plaintiff to attend the IME.
The defense will typically send a letter indicating the date of the IME, the name and specialty of the doctor who will perform it, and any request for medical records that you should take with you to the IME. If you are required to take medical records or imaging studies to the IME appointment, try not to forget them – that can give the IME doctor a poor impression of you and your intentions.
Be honest, polite, and helpful during the IME examination. Try to communicate to the doctor all information you believe relevant to your injury. And, although the doctor works for the defense, try to think of it as “just another doctor’s appointment” – because usually it is no worse an experience than meeting with any new doctor.
It is a good idea to try to arrive for your examination at least fifteen minutes early. Arriving late, even due to factors beyond your control, may create a poor first impression.
Talk To Your Lawyer
Speak with your lawyer in advance of the medical examination. Your lawyer may have special information or advice for you about the specific doctor you will be seeing. Your lawyer may wish that you emphasize certain aspects of your injury or disability during the evaluation. Your lawyer may wish that you take notes of what happened after your evaluation is over, or provide a timeline of the examination process. Your lawyer may also instruct you not to subject yourself to certain tests or procedures which are not appropriate to the IME. Finally, your lawyer will likely wish to instruct you on certain subjects and issues you should not address during your IME, such as your communications with your lawyer, the status of settlement negotiations, or your impressions of the defendant’s liability for your injury.
Not Medical Treatment
The purpose of the IME is to obtain information and expert opinion for the purposes of litigation, not to provide you with a “second opinion” or with medical treatment. Thus, the IME doctor may have you sign a form indicating your understanding that the examination does not constitute medical treatment.
What the Doctor Looks For
The IME doctor will typically conduct a patient interview to learn the history of the accident and medical condition, and then conduct a medical examination. At some point in time, the IME doctor is also likely to consult other medical records provided in relation to the plaintiff’s case. During this process, the IME doctor looks for a variety of factors about the injury victim, including:
General Appearance - The doctor will observe the plaintiff not only in the examination, but while the plaintiff walks in the examination room, how the plaintiff stands, whether the plaintiff has any difficulty climbing onto the examination table, whether the plaintiff shows any signs of distress while sitting on the examination table, how the plaintiff dresses, the plaintiff’s weight and personal hygiene, and anything else that the IME doctor believes relevant to the patient’s injury or condition.
Signs of Deception – The IME doctor will typically be on high alert for any sign of deception or exaggeration by the plaintiff, and can be expected to report any impression that the patient is intentionally or unintentionally exaggerating any symptoms, or is malingering.
Objective Manifestations of Injury – The doctor will typically review any medical imaging studies, such as x-rays, MRI reports, CT scans, and EMG nerve conduction studies, to try to find objective manifestations of injury – that is, objectively measurable damage or injury to the plaintiff’s body. The doctor will also evaluate whether the plaintiff’s subjective symptoms of pain and discomfort are consistent with the objectively verifiable manifestations of the injury.
Subjective Manifestations of Injury – The doctor will often perform tests which require the patient to provide subjective indications of pain, discomfort, sensitivity or insensitivity. For example, a doctor examining for a lower back condition may have the patient perform a variety of movements which stretch or turn the back, and note the point at which the patient starts to report pain and the point where movement becomes limited by pain. The doctor may test the subjective manifestations in several ways, or at more than one point during the examination, to see if any claimed pain level or point of disability remains consistent.
Other Contributing Factors – The IME doctor can be expected to inquire about any other ailments or injuries, including any which have occurred prior or since the accident, which may have somehow contributed to the injury, or aggravated the injury or impaired recovery since the time of the accident. The doctor will also likely address any lifestyle factors discovered within this process, such as drinking, smoking, overeating, and recreational drug use, which may somehow contribute to the injury.
The IME doctor will typically prepare at least one report for the case. Sometimes the defense will ask for a supplemental report on a specific issue, or the IME doctor will provide a supplement after reviewing additional medical records.
Don’t Expect A Fair Report
While some IME doctors are highly professional, and seek to actually provide an objective evaluation, a great many doctors know that they are being paid by the defense, and that the insurance companies which pay their bills expect that the position of the defense will be improved as a consequence of the IME report. Accordingly, many IME doctors appear to skew their reports in favor of the defense. A subset of IME doctors have a very poor reputation for fairness or accuracy, and will present whatever medical opinion the insurance company desires.
If the IME doctor prepares a report you believe to be unfair, let your lawyer worry about it. You need to be principally concerned with what your treating health care providers tell you about your condition.