Being asked to see a doctor you did not choose can be unsettling, especially when you are already receiving treatment for an injury. In New Jersey, you may be required to attend an independent medical examination (IME) as part of a workers’ compensation claim, a claim for auto insurance medical benefits, or a personal injury lawsuit. Each has different rules for requesting the exam and different consequences if you miss it.
An IME gives another party a medical opinion about your condition; it does not replace your treating doctor or decide your claim on its own. Understanding who requested the exam is the first step toward knowing what is required and how to respond.
Key Takeaways: When Are IMEs Required in New Jersey?
- In a workers’ compensation claim, an injured employee must attend an employer-requested exam at a reasonable time and place in New Jersey.
- In a filed personal injury lawsuit, the opposing party can generally request an initial exam by serving notice under New Jersey’s court rules.
- An auto insurer may request an exam when your condition matters to a claim for personal injury protection (PIP) medical benefits.
- Missing a required exam can affect your claim, but the consequences differ by claim type.
- An IME report is a medical opinion. It does not automatically decide the outcome of your case.
What Is an Independent Medical Examination?
An IME is an evaluation arranged to answer questions about an injury claim. The examiner may review your records, ask about your symptoms and medical history, perform a physical examination, and prepare a report. The requesting party or insurer generally selects the examiner.
Despite its name, an IME is different from an appointment with a doctor who treats you. The examiner may be asked about whether an injury is related to an accident, whether further treatment is needed, whether you can work, or whether you have lasting limitations. The questions will depend on the claim.
When Can Your Employer Require an IME for Workers’ Compensation?
Under New Jersey’s workers’ compensation law, an employee must submit to a physical examination after an injury if the employer requests one. The examination must take place at a reasonable time and place within New Jersey, and additional examinations must be reasonably requested.
An exam might be used to assess ongoing treatment, the employee’s ability to return to work, or the extent of a lasting injury. The law also gives an employee the right, upon request, to have a physician of their own choosing present to participate in the examination.
Refusing an examination that meets the law’s requirements can suspend the employee’s right to workers’ compensation during the refusal. If the appointment presents a problem, such as an unreasonable location or a scheduling conflict, raise it promptly rather than simply missing the exam.
When Is an IME Required in a Personal Injury Lawsuit?
If you file a personal injury lawsuit, the opposing party may request an examination when your physical or mental condition is in dispute. Under New Jersey Court Rule 4:19-1, the opposing party can generally arrange the initial exam by serving a notice that identifies when, where, and by whom it will be conducted. The notice must also describe the nature of the examination and any proposed tests to the extent practicable.
The exam cannot be scheduled sooner than 45 days after the notice is served. A court order is not ordinarily required for the first examination. If you object to the request or its terms, you can ask the court for a protective order. A reexamination by the opposing party’s expert requires your consent or a court order.
This rule applies to a filed lawsuit. Receiving a settlement offer or making an insurance claim does not, by itself, mean the other side can require a lawsuit exam under the court rule.
When Can an Auto Insurer Request an IME for PIP Benefits?
A car accident can lead to a separate examination connected to your auto insurance medical benefits. When your condition matters to a claim for PIP benefits, an insurer may request an examination to review issues such as the medical need for further treatment or testing.
New Jersey’s PIP regulations include requirements for examinations used to review further care. These address notice, the examiner’s discipline, a reasonably convenient location, and the insurer’s response after the exam. The regulations also address the potential consequences of repeated, unexcused failures to attend an exam under an insurer’s review plan.
A PIP exam concerns your auto insurance benefits. It serves a different purpose from an exam requested by the defendant after a personal injury lawsuit is filed, even if both arise from the same crash.
What Happens If You Miss a Required IME?
The answer depends on which rule applies. In a workers’ compensation claim, refusing a qualifying employer-requested exam can suspend compensation for the period of refusal. In a personal injury lawsuit, the court may order compliance and can impose more serious consequences for failing to attend or address the notice under the court rule. In a PIP claim, missing an exam may affect reimbursement for further care under the applicable requirements.
An exam notice should be taken seriously, but it is also reasonable to check whether the request follows the rules for your claim. If you cannot attend at the scheduled time, notify your attorney or the appropriate contact promptly and keep a record of your efforts to reschedule.
Preparing for an IME
Review your treatment history so you can accurately describe your symptoms, prior injuries, current limitations, and care. You do not need to memorize answers. Be honest about what you can and cannot do, and avoid guessing about a diagnosis or how long recovery will take.
The examiner may include your account of the injury and your symptoms in a written report. If something about the proposed exam concerns you, such as the location, proposed testing, or a conflict with your medical restrictions, discuss it with your attorney before the appointment. Do not assume that an objection excuses you from attending.
Can You Challenge an Unfavorable IME Report?
An unfavorable report does not automatically end a workers’ compensation or personal injury claim. Its conclusions can be compared with your treatment records, test results, medical history, and opinions from doctors familiar with your condition. An attorney can also examine whether the report accurately describes what you said and what occurred during the exam.
What happens next depends on the dispute. For example, the parties may seek additional medical evidence or ask a court or workers’ compensation judge to resolve a contested issue. If the exam concerns PIP benefits, New Jersey’s rules provide ways to request a copy of an examiner’s written report.
Questions About an IME? Contact Brandon J. Broderick
An IME notice can be confusing because the requirements are different for workers’ compensation, PIP benefits, and personal injury lawsuits. Brandon J. Broderick, Attorney at Law can help you understand why the exam was requested, review the notice, and address concerns about an examiner’s findings.