Independent Medical Exam (IME): What to Expect and Prepare

The word independent is a misnomer. The examining doctor is chosen by the insurer or defense attorney, paid by them, often examines claimants for them regularly, and produces a report they will use. Many IME doctors earn a substantial part of their income from these examinations, and insurers select doctors whose opinions have been useful before. The exam is better understood as a defense medical examination, which is what some states' rules call it.

The purpose is to produce a medical opinion that limits the claim: that the injury has resolved, that the ongoing symptoms are not related to the crash, that the condition was pre-existing, that the treatment was excessive, or that no further treatment is needed. The report also records the doctor's observations of how you moved, sat, walked to the car, and described your symptoms, and those observations are compared with your records and with any surveillance.

An IME is not treatment. The doctor is not your physician, owes you no duty of care, will not advise you, and is not bound by confidentiality toward you. Anything you say is reported. The exam is typically brief, often fifteen to thirty minutes of actual examination after a longer history, and the report is often lengthy, because much of it is drawn from the records review.

For a claim on your own policy, medical payments, personal injury protection or uninsured and underinsured motorist coverage, the policy's cooperation clause requires you to attend an examination the insurer reasonably requests, and refusing can forfeit the benefits. No-fault states' PIP rules commonly provide for insurer examinations, and failure to attend can end PIP benefits. Attend, but prepare.

For a third-party claim against the other driver's insurer before any lawsuit is filed, you have no obligation to the other driver's insurer and can decline. Once a lawsuit is filed, the court's rules allow the defense to request an examination when the physical condition is in controversy, which it is in every injury case, and the court orders it on terms: the specialty, the scope, the location, and often whether a witness or recording is permitted. Attend as ordered; refusing an ordered exam has serious consequences for the case.

An attorney negotiates the terms: that the doctor be in an appropriate specialty, that the exam be limited to the injury claimed, that no invasive tests be done, that a witness or recorder be permitted where the state allows, and that the report be produced promptly. These terms matter, and they are set before the exam, not at it.

Suppose you were rear-ended and have had eight months of neck and shoulder pain, with an MRI showing a bulging disc and a treating orthopedist's opinion that the crash caused it and that you have a permanent limitation. The other driver's insurer disputes the permanency, a lawsuit is filed, and the defense schedules an IME with an orthopedist who examines claimants for that insurer regularly.

You attend with a nurse observer your attorney arranged, as the state's rules permit. The history takes forty minutes; the physical examination takes twelve. The doctor asks how the crash happened and whether you have a lawyer; you answer that you are there about the injury and your attorney has the file. He asks about a back complaint from ten years earlier; you answer accurately that it resolved with no treatment after a few weeks.

The report concludes the disc bulge is degenerative, unrelated to the crash, and that you have no permanent limitation, citing your ability to remove your jacket without apparent difficulty. The nurse observer's notes record that you removed it slowly using the uninjured arm, and the treating orthopedist's response addresses the degenerative finding with the pre-crash absence of symptoms. The IME report is one opinion among several, and at mediation the defense's own reliance on it is tempered by the doctor's history of similar opinions. The pattern is typical.

The exam is a comparison of what you say and do with what the records say. Preparation is about accuracy, not performance.

• Review your own treatment history beforehand so your account of the injury, the symptoms and the treatment is accurate and consistent with the records.
• Answer questions about the injury and its effects accurately and completely; do not exaggerate, and do not minimize.
• Decline to discuss how the crash happened, who was at fault, your legal claim or your attorney's advice; say the exam is about the injury.
• Answer questions about prior injuries and conditions accurately; the insurer has your records, and an inaccurate denial is worse than the prior condition.
• Assume you are being observed from the moment you arrive in the parking lot until you leave; move as you normally do.
• Bring a witness, a nurse observer or a recorder where the state and the exam terms permit, and have them note the start and end time of the actual examination.
• Do not sign anything at the exam, and do not fill out a questionnaire about the crash or the claim without your attorney seeing it first.
• Write down afterward what was asked, what was examined, and how long it took, while it is fresh.

Whether you can bring a witness or record the exam varies. Some states give the examinee an express right to have a representative present and to record; others leave it to the court's discretion in each case; a few permit the examiner to refuse. The exam terms your attorney negotiates or the court orders govern. Several states also require the examiner to produce a copy of the report to the examinee on request, and some restrict how many examinations the defense may demand.

In no-fault states, PIP examinations are governed by the state's no-fault statute and the policy, which typically require attendance and allow the insurer to suspend benefits for non-attendance; the rules on challenging an unfavorable PIP exam result differ by state. In Florida and New York the PIP examination process is a routine point at which benefits are cut off, and the response is through the state's dispute process.

Litigation rules on examinations follow each state's civil procedure rules, which generally require that the condition be in controversy and that the court find good cause, and which let the court set the conditions. Federal court applies its own rule. A refusal to attend an ordered exam can result in the injury claim being limited or dismissed, so an objection to the terms is made to the court beforehand, not by non-attendance.

The IME report goes to the insurer or defense, and in litigation it is produced to your attorney. It is answered: your treating doctors address its conclusions in their own records or in a response, and where the permanency or causation question is central, your own retained expert may examine you and report. The examiner can be deposed about the report, the exam's length, the records reviewed, and the doctor's history of examining for insurers and the fees earned, which is admissible to show bias in most states.

In a first-party PIP or medical payments claim, an unfavorable IME is commonly used to terminate benefits, and the response is through the policy's and the state's dispute process, which may include arbitration or a lawsuit against the insurer. In a third-party claim, the report is a negotiating position and trial evidence, weighed against the treating doctors' opinions, and juries are told who paid for it.

An IME report that finds the injury resolved does not end the claim. It is one opinion, from a doctor who saw you once for the defense, against the record of treatment by doctors who saw you repeatedly and had no stake in the outcome. The claim is decided on the whole record.

An IME is a defense tool, and how it goes depends on the terms set beforehand, on accurate and limited answers during it, and on the treating doctors' response afterward. The questions to answer early are whether you are required to attend, what terms can be negotiated or ordered, and whether a witness or recorder is permitted in your state. These are questions an attorney handles as part of the claim, on contingency.

Ask Legal Matters is a free claim-review request service, not a law firm. Requests may be shared with independent attorneys and legal services partners who handle inquiries in your state, and an attorney must evaluate the facts before anyone can say what the claim is worth. If an insurer has scheduled an independent medical exam on your claim, you can request a free claim review before you attend.

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Need local rules? Choose your state from the injury law guides hub or read the statute of limitations by state.