What is an independent medical exam for workers compensation claim?

IME stands for independent medical examination. An IME is a medical examination performed by an independent doctor who does not work for the employer or the insurer. The IME can be required by the insurer at any point of your claim, and you usually have to attend.

If you have made a workers’ compensation claim, the IME is usually conducted by a WorkCover Approved Specialist or AMS doctor. One of the main reasons IME can be helpful is that an independent doctor may have a different approach to treating your injury and it’s important for you to get the full extent of treatment options available. An IME will also show if there are any work restrictions that might affect your compensation claim, or your ability to return to work.

In addition to an IME, it’s always a good idea to see your own doctor and get their opinion on what treatment options are available for you.

What is an independent medical exam IME and why is it done?

An IME, independent medical examination, is a medical examination that can be conducted by an independent medical examiner for medical-legal purposes. In workers compensation claims in Western Australia, an IME is conducted by a WorkCover approved independent medical specialist (AMS).

IMEs are done for a variety of reasons. The reasons that a workers compensation insurance company may choose to send you to an approved medical specialist include:

1. To assess your degree of whole person impairment – Usually the higher the percentage impairment, the more money you will receive from the employer’s insurance company upon settlement of your claim;
2. To assess whether you meet the 15% whole person impairment threshold to bring a common law claim against your employer;
3. To determine whether you are fit for your pre-injury work, or whether you are fit for alternative employment;
4. To determine the need for medical treatment, especially in the treatment is expensive, for instance, a fusion operation.

What is the purpose of an independent medical examination?

IME for Workers Compensation Claim

In workers compensation claims it is common for the insurance company to send you for an independent medical evaluation (another name for an IME). This can happen at any point during the workers compensation claim process. If you are represented by a workers compensation lawyer it is likely they will also send you to IME doctors to obtain another opinion regarding your whole person impairment, need for medical treatment and fitness for work.

What does an independent medical examiner do?

An IME medical examiner or IME doctor will generally have at least some access to documentation from your treating doctor and may have a copy of your medical history which has been obtained from your General Practitioner. They will read these medical records and then meet with you to evaluate your medical condition.

Workcover approved medical specialists

In Western Australia, your treating doctor has an important role in the workers compensation claim process, however, only WorkCover Approved Medical Specialists (AMS) can conduct an assessment of your whole person impairment.

Generally speaking, the IME doctors used by the workers compensation insurance company and your workers compensation lawyers will be qualified as an AMS.

Workcover guidelines on independent medical examinations and reports

It is important to realise that the process of a workers compensation case in Western Australia can be quite complicated.

To request an assessment of a worker’s degree of whole person impairment an injured person or their lawyer needs to provide the AMS IME doctor with a WorkCover WA form AMS1. If the employer’s insurance company also wants an independent medical examination of whole person impairment they will need to provide the IME doctor with the same form.

Following a meeting to assess your medical condition and review your medical records, the AMS IME Doctor will provide the person requesting the report with an IME report which includes:

1. Forms AMS 7 and AMS 8 if the worker’s condition has not stabilised; or
2. Forms AMS 6 and AMS 5 if the worker’s condition has stabilised.

Throughout the process of a workers compensation claim, several independent medical examinations may be requested by your lawyer or the insurance company. This is very common in the situation when the injured person suffers a secondary physiological injury as a result of the initial physical injury.

In some circumstances, the worker’s condition may not have stabilised but the AMS IME Doctor can provide a ‘special evaluation’ report which provides an assessment of the worker’s whole person impairment.

IME for a job

Occasionally workers with a workers compensation case will be sent to an IME doctor directly by their employer, as opposed to an assessment through the workers compensation insurance company.

This is usually to assess whether the injured worker is able to return to their pre-injury role or any role with the employer for which they have suitable education training and experience.

In the event that no role can be found with the employer then the employer may choose to terminate the worker’s employment. If this occurs the injured worker should seek advice from a good lawyer specialising in employment law.

What can I expect from an independent medical exam?

Independent medical exams are arranged by the workers compensation insurer for the purpose of claims management regarding a workplace injury. It is important to realise that the insurer is sending you for such a review to manage the expenses associated with your workers comp claim. The independent medical exam will affect how much the insurer is willing to offer you for your permanent impairment, additional medical treatment and in future weekly payments of compensation.

In workers comp case settlements, significant weight is usually placed on the medical opinion provided in IME reports though the insurer will also consider what you have to say and opinions from your general practitioner and treating physician. The IME report prepared by the AMS doctor is also called the AMS report.

Independent medical examination questions

Independent medical examiners will generally review your medical history and then ask you questions about your workplace accident and workers comp claim. You will be asked questions about your past medical history, current abilities and disabilities and what your life involves. The IME doctor will ask questions about the medical treatment you have had and the medical and like expenses incurred regarding your case.

The IME doctor will then conduct a physical examination of injured workers (if the claim is for a physical injury). Generally, this assesses things like your range of movement.

What should you not say in an independent medical exam?

We recommend you arrive early for an IME and take with you records such as x-rays regarding your workers compensation claim.

An IME doctor is usually an experienced medical practitioner. It is important that you do not over exaggerate the extent of your injuries and you do not minimise the extent of your current symptoms.

If you over-exaggerate your symptoms, then the IME physician may form the view that you are not being truthful regarding your work-related injury and this could result in a claims issue regarding your work injury.

How do I pass an independent medical exam?

Concepts such as passing or failing are not relevant to a medical examination conducted by an IME doctor. These independent medical examinations are arranged primarily to review relevant information (including any previous injuries) and provide an independent opinion medical report (i.e. IME report) regarding your need for medical treatment and entitlement to wage loss benefits.

What problems usually arise from an IME?

It is common for injured workers to disagree with IME reports arranged by the workers compensation insurer. The following issues often arise:

1. The IME doctor will say one thing during the consultation and then the doctor makes a report stating something else. It can be helpful to bring a family member to the independent doctor’s review.
2. The injured worker does not agree with the IME medical report or medical reports arranged by the insurer. In this case, if the injured worker has a workers compensation lawyer, their legal representative can assist them in arranging an assessment of their permanent impairment, work capacity and need for medical care regarding the work-related incident.

There is usually a big difference between the doctor’s report prepared for the worker’s compensation insurer and an appropriately qualified doctor’s report arranged through an experienced workers comp attorney. Obtaining a medical evaluation report regarding a worker’s injury through a workers compensation lawyer is often significantly affect the potential value of a claim.

Assistance for Independent Medical Examinations

Foyle Legal acts as the legal representative of injured workers in workers compensation claims in Western Australia and provides this representation on a no win no fee basis. Rated as one of the top personal injury lawyers in Perth, we help injured people to maximise compensation and get the most from the insurance company. We routinely help with FIFO workers comp, construction accident workers comp and more, and developed extensive knowledge on independent medical examinations. If you have made a WorkCover claim in WA, contact Foyle Legal for your obligation free consultation.