The Independent Medical Exam in Pennsylvania Workers Comp: What It Is For

The name is doing a lot of work

The examination is not neutral in any meaningful sense. The insurer selects the physician, pays them, sends them a curated set of records, and asks specific questions. Many examiners derive a substantial part of their income from this work.

That does not make the report worthless, and it does not mean the examiner is dishonest. It means the report is evidence produced by one side, and it should be treated as such rather than as a verdict.

Go, but go prepared

Refusing a reasonable examination request can result in your benefits being suspended, so attendance is not really optional. What you can control is how you present.

• Be accurate, not stoic and not dramatic. Describe a typical day, including the bad ones and the better ones. Overstating is the fastest way to lose credibility, and understating is the most common mistake injured people make because they are used to coping.
• Be consistent with your treating records. Contradictions between what you tell this doctor and what you told your own are what the report is built on.
• Do not guess. “I do not remember” is an acceptable answer and a far better one than a wrong date.
• Note the details. How long the examination lasted, what was actually examined, whether anybody took a history. A report describing a thorough examination that took eight minutes is challengeable.
• Take somebody with you where permitted, and write everything down immediately afterwards.

Assume you are being watched

Surveillance around IME appointments is routine. So is a review of your social media. The walk from the car park is frequently the most photographed part of these cases.

The point is not to perform. It is that a person who tells the examiner they cannot lift and is filmed carrying a toddler has a problem, even where both things are true on different days. Be accurate about your range of function, including what you can do on a good day, because that is the honest version and it is also the defensible one.

What happens after

If the report supports the insurer, expect a Notice of Ability to Return to Work, a petition to terminate or modify benefits, or a settlement offer timed to arrive before you can challenge the report.

The response is medical evidence of our own: the treating physician’s opinion, sometimes an examination we arrange, and cross examination of the IME physician at deposition about their methodology, the time spent, and what records they were and were not sent.

The impairment rating evaluation is a different thing

After 104 weeks of total disability the insurer can request an impairment rating evaluation, which is not the same as an IME. It measures whole body impairment against a published guide, and if the rating falls below the statutory threshold your status can change from total to partial, capping benefits at 500 weeks. It has its own rules and its own deadlines, and it deserves separate attention.