Independent Medical Examinations and Workers' Comp Claims

Injured person undergoing a physical evaluation, with a medical professional assisting arm movement during an independent medical exam.

Why Insurance Companies Use IMEs to Challenge Work Injury Claims

If you’ve filed a workers’ compensation claim in Pennsylvania, you may be required to attend something called an Independent Medical Examination, or IME. This can be one of the most frustrating parts of the process, especially when the doctor isn’t your own, the exam feels rushed, and the results are used to question the validity of your work injury.

An Independent Medical Exam is a physical evaluation requested by the insurance company, not by your treating physician. The stated purpose of an IME is to provide an objective medical opinion about your condition. In practice, it’s used to support the insurer’s claim that you are no longer injured, that your treatment is unnecessary, or that you are ready to return to work.

Unfortunately, IMEs are a standard tool used by workers’ compensation insurers in Pennsylvania. They are not neutral medical evaluations. They are part of a larger strategy designed to challenge your right to benefits. If you’re scheduled for an IME, it’s important to understand what to expect, what your rights are, and how a workers’ compensation lawyer can help protect you from a one-sided report.

IMEs in Workers' Comp Cases

IMEs play a central role in many efforts to reduce, suspend, or terminate workers' compensation benefits. These exams often precede legal action from the insurer. The doctor performing the IME does not treat you and will not provide care or follow-up. They are typically paid by the insurance carrier and are often selected based on their past willingness to support the denial or modification of claims. IMEs are commonly scheduled after you’ve been receiving benefits for a period of time, when medical treatment is ongoing, or when the insurer is preparing to challenge your claim in court.

Some of the most common ways IME results are used against injured workers include:

Claiming You’ve Recovered: The report may say your injury has resolved, even if your own doctor disagrees.
Recommending Reduced Treatment: The IME may state that additional care, therapy, or medication is unnecessary.
Arguing You Can Return to Work: The exam may be used to support a claim that you can handle light-duty or full-duty work.
Challenging the Cause of Injury: Insurers may try to argue that your condition is not work-related or stems from a pre-existing issue.

These reports often serve as the foundation for a formal petition to modify, suspend, or terminate benefits. If you're unprepared or unrepresented, the IME can be a turning point that jeopardizes your access to medical care and income support.

What to Expect During an IME

Independent Medical Exams often feel brief and impersonal. The doctor may have already reviewed your medical records and may only conduct a basic physical examination.

Because IMEs carry significant legal weight, it is important to approach the exam with caution and a strategic mindset. Here are some key things to expect and prepare for:

The Doctor May Ask About Your Injury: You’ll likely be asked to describe how the injury occurred, how you feel now, and what treatment you’ve received.
The Exam May Be Superficial: Some workers report that the exam feels more like a formality than a real evaluation.
The Doctor May Observe How You Walk, Sit, or Move: These observations can be used to claim you’re exaggerating symptoms or not as injured as claimed.
You Will Not Receive Medical Advice: The doctor will not give you treatment recommendations or discuss your care plan.

While you can’t avoid the IME, you can take steps to protect yourself during and after the appointment.

How to Protect Yourself Before, During, and After the Exam

Many injured workers don’t realize the influence an IME report can have until it’s too late. Preparing for the exam in advance can help safeguard your rights and avoid unintentional missteps.

Be Truthful But Brief: Answer questions clearly, but don’t over-explain or speculate.
Don’t Exaggerate or Minimize Symptoms: Stick to your actual experience and limitations.
Take Note of the Doctor’s Behavior: Write down what happened immediately afterward, especially if something felt off.
Request a Copy of the Report: You have a right to know what was written and how it might affect your case.

These steps can make a meaningful difference in how your case is handled. If the IME leads to a dispute over your benefits, your attorney can use your notes and documentation to challenge the report’s credibility.

Your Rights Under Pennsylvania Law

Under Pennsylvania law, insurers can request IMEs no more than twice a year without court approval. You are required to attend, but you also have legal protections.

Some of the rights available to injured workers include:

The Right to Present Your Treating Doctor’s Opinion: Your physician’s records can carry more weight with the judge if properly documented.
The Right to Challenge Biased Reports: If the IME is used to reduce your benefits, you can request a hearing and submit evidence in your defense.
The Right to Legal Representation: You do not have to face the insurance company’s tactics alone.

Pennsylvania workers’ compensation judges regularly see cases involving disputed IME reports. Having legal counsel who understands how to address these challenges is critical to protecting your claim.

Talk to a Workers’ Compensation Attorney Today

When an insurance company schedules an IME, it’s usually to find a reason to reduce or terminate your benefits. These exams aren’t neutral, and the report can carry serious weight in your case.

An experienced workers’ compensation lawyer can prepare you for the exam, review the report for bias, and challenge it in court if necessary. If the insurer tries to use the IME to reduce or end your benefits, your lawyer can fight back with strong medical evidence and legal strategy.

Handled improperly, an IME can cost you. The right lawyer helps make sure it doesn’t.

If you’ve been scheduled for an IME or are already facing a dispute over your benefits, don’t wait for the insurer to decide what happens next. Vellner Law, PC represents injured workers in Allentown and across the Lehigh Valley. We understand how these exams work, how the system is biased, and how to counteract when the insurance company overreaches. Contact us today for a free consultation.

"Attorney Vellner represented me in a nearly two-year ordeal with workmans compensation. He did a wonderful job representing me and was extremely professional. He was always readily available to answer questions, and give me advice. He never missed a step and handled every bump that crossed our paths. Anyone struggling with a work injury would be lucky to have him as their representation; I highly recommend him." — Katie T., ⭐⭐⭐⭐⭐