What Happens at a Pennsylvania Workers’ Compensation IME?

If you have a Pennsylvania workers’ compensation claim, the employer or insurance carrier may require you to attend an Independent Medical Examination, commonly called an IME. The examination is performed by a health-care provider selected and paid by the employer or insurer. Its purpose is to evaluate issues such as diagnosis, work-relatedness, disability, restrictions, treatment and recovery.

An IME is not the same as treatment from your own doctor. The examining physician is not taking over your care. The exam may instead become evidence in the workers’ compensation case, including evidence used to support a petition to terminate, modify or otherwise change benefits.

What Gives the Employer the Right to Request an IME?

Section 314 of the Pennsylvania Workers’ Compensation Act permits an employer to request that an injured employee submit to a physical examination or expert interview at a reasonable time and place by an appropriate health-care provider or other expert selected and paid by the employer.

If the employee refuses to attend, the employer may petition a Workers’ Compensation Judge for an order compelling the examination. The statute also allows the judge to order additional examinations when reasonable and necessary.

Is an IME Really “Independent”?

The term “Independent Medical Examination” is widely used, but the physician is generally chosen and paid by the employer or insurance carrier. The doctor is not your treating physician and does not have the same role as a provider who is responsible for your ongoing care.

For that reason, it is usually more accurate to think of the IME as a defense medical examination. The physician’s opinions may be used by the employer or insurer in workers’ compensation litigation.

Why Do Insurance Companies Request IMEs?

An IME may be requested for several reasons, including to evaluate:

whether the claimed condition is related to the work injury;
whether the accepted description of injury is accurate;
whether the employee remains disabled;
whether the worker can return to full-duty or modified work;
whether current medical treatment remains related to the work injury;
whether the employee has fully recovered;
whether restrictions remain necessary; or
whether the carrier should file or defend a workers’ compensation petition.

What Happens During the IME?

The exact exam depends on the injury and medical specialty, but a typical IME may include:

review of medical records provided to the physician;
a history of the work injury;
questions about prior injuries and medical treatment;
questions about symptoms, treatment and medications;
questions about current work status and daily activities;
a physical examination;
review of diagnostic imaging or testing; and
preparation of a written medical report.

The examination itself may be shorter than a treating medical visit because the physician is evaluating specific issues for the workers’ compensation case rather than developing an ongoing treatment plan.

What Should You Bring to the IME?

Follow any written instructions provided for the examination. Depending on the circumstances, you may be asked to bring:

photo identification;
a medication list;
diagnostic images or records not already supplied;
assistive devices you regularly use, such as a brace or cane; and
information needed to complete the physician’s intake forms.

Do not assume you need to independently assemble your entire medical history unless instructed to do so. The employer or carrier often sends records directly to the IME physician.

How Should You Describe Your Symptoms?

Be accurate and consistent. Do not exaggerate symptoms, but do not minimize them either.

If a movement hurts, say so. If you can perform an activity only for a limited time or with difficulty, explain the limitation rather than answering as though the activity is simply possible or impossible.

Medical records, surveillance, prior testimony and your statements to other physicians may later be compared with what you report at the IME. Credibility can become important in a contested case.

Should You Discuss Prior Injuries?

Yes, when asked. A prior injury does not automatically defeat a workers’ compensation claim. Pennsylvania law can recognize a work-related aggravation of a preexisting condition.

Trying to conceal prior treatment is usually far more damaging than accurately explaining how the current work injury differs from the earlier condition.

Can the IME Doctor Order Treatment?

The IME physician is generally evaluating the claim rather than treating you. The doctor may offer opinions about whether treatment is necessary or related, but your treating medical decisions remain separate.

An IME report can nevertheless affect the litigation. For example, the defense physician may opine that no further treatment is necessary, that a different diagnosis is appropriate, or that the employee has fully recovered.

Can the IME Doctor Say You Are Fully Recovered?

Yes. A defense physician may issue an opinion of full recovery if the physician believes the work injury has resolved.

The employer may use that opinion as evidence in a Termination Petition seeking to end workers’ compensation benefits. The treating physician may disagree, and the Workers’ Compensation Judge may ultimately have to decide which medical evidence is more credible.

Can the IME Doctor Send You Back to Work?

The IME physician may give an opinion that you can return to full-duty or modified work. That opinion can influence the employer’s litigation strategy or job-offer process.

Whether benefits can actually be reduced or suspended depends on the procedural posture, available work, medical evidence and Pennsylvania law. The doctor’s opinion alone does not automatically change a Workers’ Compensation Judge’s existing order.

What If the IME Is Far From Home?

Section 314 requires the examination to occur at a reasonable time and place. Reasonableness can depend on distance, travel burden, the worker’s physical condition and other circumstances.

If the requested location creates a legitimate hardship, the issue should be raised promptly rather than simply failing to appear.

How Often Can an Employer Require an IME?

Pennsylvania law permits examinations requested under Section 314 and gives Workers’ Compensation Judges authority to determine whether additional examinations are reasonable and necessary. In practice, repeated examinations can become disputed when they are excessive, duplicative or unusually burdensome.

Workers should not assume that every new examination request is automatically improper, but they also should not ignore legitimate concerns about frequency or reasonableness.

What Happens If You Do Not Attend?

Ignoring an IME request can create serious problems. If an employee refuses to submit to a proper examination, the employer may file a petition asking a Workers’ Compensation Judge to compel attendance.

Failure to comply with an order can affect benefits. If you cannot attend because of illness, transportation problems or another legitimate reason, communicate promptly rather than simply missing the appointment.

Can Someone Go With You?

Whether another person may be present during the actual examination can depend on the circumstances, the physician’s office and any legal dispute about the examination. A worker may still want someone to drive or accompany them to the location if medically appropriate.

If there is a specific concern about recording, observation or another person being present during the exam, legal advice should be obtained beforehand.

Can the IME Be Recorded?

Do not assume you have an unrestricted right to record the examination. Recording can raise legal, procedural and office-policy issues. If recording is important, discuss the issue with counsel before the appointment rather than attempting to record secretly.

What Should You Do Immediately After the IME?

As soon as practical, write down what happened while the details are fresh. Useful notes can include:

arrival and departure time;
how long the physician actually examined you;
questions asked;
movements or tests performed;
symptoms that occurred during the examination;
statements made by the physician; and
anything unusual about the appointment.

Those notes can be useful if the physician’s later report describes the examination differently from what you remember.

Will You Receive a Copy of the IME Report?

The defense physician typically sends a report to the party that requested the examination. In litigation, the report may be provided through counsel or discovery and may later form the basis for medical testimony.

The report can contain opinions about diagnosis, causation, work ability, treatment, restrictions and recovery.

Can the IME Doctor Testify?

Yes. In contested Pennsylvania workers’ compensation cases, physicians commonly testify by deposition. The IME doctor may be questioned by the employer’s attorney and cross-examined by the employee’s attorney.

The treating physician may also testify, and the Workers’ Compensation Judge decides credibility and the weight given to conflicting medical opinions.

How Can an IME Affect a Denied Claim?

In a denied Claim Petition, the employer may use an IME to challenge whether the injury occurred, whether the condition is work-related, or whether the worker is disabled.

For more information about denied claims, see What Happens When Your Pennsylvania Workers’ Compensation Claim Is Denied?.

How Can an IME Affect an Accepted Claim?

Even after a claim is accepted, an IME can lead to additional litigation. Depending on the physician’s opinion, the employer may consider filing a petition to:

terminate benefits based on full recovery;
modify benefits based on work capacity or earning power;
suspend benefits in appropriate circumstances; or
challenge the extent or description of the accepted injury.

The correct petition and burden of proof depend on the specific issue.

Is an IME the Same as an IRE?

No. An Independent Medical Examination under Section 314 is different from an Impairment Rating Evaluation (IRE).

An IRE is a statutory examination used to determine whole-body impairment under Pennsylvania workers’ compensation law and follows a separate process administered through the Bureau of Workers’ Compensation. The two examinations serve different purposes and should not be confused.

Practical IME Checklist

Confirm the date, time and location.
Arrive on time.
Follow written instructions about records or imaging.
Answer questions truthfully and accurately.
Do not exaggerate or minimize symptoms.
Describe prior injuries honestly.
Do not guess when you do not know an answer.
Do not argue with the physician.
Make notes immediately afterward.
Tell your attorney about any unusual issue or major statement made during the exam.

Frequently Asked Questions

Can I refuse a Pennsylvania workers’ compensation IME?

A worker generally must cooperate with a reasonable examination requested under Section 314. If there is a legitimate objection, it should be addressed through the proper legal process rather than by simply refusing to attend.

Will the IME doctor become my doctor?

No. The IME physician is generally evaluating the workers’ compensation claim, not establishing an ongoing physician-patient treatment relationship.

Can my benefits stop immediately after an IME?

Not simply because the IME doctor disagrees with your treating physician. The employer may need to follow the procedures required by Pennsylvania law, which can include filing a petition and obtaining a decision from a Workers’ Compensation Judge.

What if my treating doctor disagrees with the IME?

That is common in contested cases. Both physicians may present evidence, and the Workers’ Compensation Judge decides which testimony is more credible and persuasive.

Related Pennsylvania Workers’ Compensation Resources

Talk with a Pennsylvania Workers’ Compensation Attorney

ZwickLaw represents injured Pennsylvania workers in denied claims, IME disputes, petitions, hearings and settlements. Learn more about Matthew R. Zwick, review the firm’s Workers’ Compensation practice, or contact ZwickLaw to discuss a work-injury claim.

This article provides general information and is not legal advice. IME requirements, objections, petitions and the effect of medical opinions depend on the facts, procedural history and current Pennsylvania law.

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