Glossary
Independent medical examination, defined
An evaluation of an injured person by a physician who has no treating relationship with them, arranged by an insurer or ordered by a court to give a second opinion on diagnosis, causation, treatment or impairment. It is common in workers compensation, auto injury and disability claims.
In practice
The carrier chooses and pays the examiner, so the opinion is not neutral in the way the name suggests, and claimants' attorneys treat the report as one side's evidence. It is typically requested when treatment runs longer than expected, when the treating physician's findings look out of proportion to the injury, before a maximum medical improvement decision, or when a permanent disability rating is disputed. Most states' rules let a claimant's own physician respond and let a judge weigh both. For an employer or policyholder the practical point is that the request is routine, not an accusation, and refusing to attend can suspend benefits under many policies and state rules. The analysis explains what the examiner will look at and what happens if the two opinions differ.
A worked example
Suppose an employee's treating physician has kept him off work for ten months with a back strain and recommends a further year of therapy. The carrier arranges an evaluation with an orthopaedic specialist, who finds the strain resolved and the employee able to do modified work. Benefits of $650 a week are placed in dispute; a hearing officer reviews both reports and orders a return to light duty. Hypothetical figures, to show the mechanism.
Applies to: Workers' Compensation InsuranceAuto Insurance