Independent Medical Examinations (IMEs) are a common part of workers’ compensation and personal injury claims in Pennsylvania. These evaluations play a significant role in determining the extent of an individual’s injuries and whether benefits should continue. While many injured workers are unfamiliar with the process, knowing when an IME may be required can help reduce uncertainty and prepare claimants for what to expect.

What is an Independent Medical Examination?

An IME is a medical evaluation conducted by a doctor chosen and paid for by the insurance company or employer. Unlike a treating physician, the IME doctor is not there to provide care or treatment. Instead, the purpose of the exam is to provide an independent opinion on specific medical issues related to the injury.

Key goals of an IME include:

Because the insurance company selects and compensates the IME physician, injured workers often worry about bias. Still, Pennsylvania law sets limits on how often and under what circumstances these exams may be scheduled.

When IMEs Are Requested in Pennsylvania Workers’ Compensation Claims

In Pennsylvania, an IME may be scheduled any time an employer or insurer disputes the ongoing need for treatment or wage-loss benefits. The state workers’ compensation statute provides specific guidelines on frequency and timing.

Frequency limits

Employers or insurers are permitted to require an IME once every six months. This prevents excessive exams but still allows the insurer to regularly evaluate the claimant’s condition.

Common reasons for IME requests

  • The insurance company questions whether treatment is still necessary
  • There is uncertainty about whether the injury is work-related
  • The injured worker has reached maximum medical improvement and the insurer wants to confirm the status
  • A doctor’s recommendation for surgery or extensive therapy needs verification
  • The insurer believes the worker may be able to return to work in some capacity

IMEs in PA Personal Injury Lawsuits

While IMEs are most often associated with workers’ compensation, they can also arise in Pennsylvania personal injury lawsuits such as car accidents, slip and falls, or premises liability claims.

Defense requests in litigation

When an injured person files a lawsuit seeking damages, the defendant or their insurance company may request an IME to challenge the extent of the injuries. For example, if a plaintiff claims permanent disability, the defense may require an IME to obtain an alternative opinion. Courts typically grant these requests as long as they are reasonable and limited to relevant medical issues.

Role of IMEs in settlement negotiations

An IME can heavily influence how a personal injury case progresses. If the defense doctor concludes that injuries are minor or unrelated to the incident, the insurer may offer a lower settlement. Conversely, if the IME findings confirm severe impairment, it can strengthen the plaintiff’s claim for compensation.

Rights of the Injured Worker or Plaintiff

Even though IMEs are arranged by the opposing party, injured workers and plaintiffs have rights during the process.

Right to notice

You must receive advance notice of the exam, including details about the doctor and location.

Right to challenge

If you believe an IME request is unreasonable, such as being scheduled too frequently or unrelated to the injury, you may be able to challenge it before a workers’ compensation judge or the court.

Right to bring someone

In many cases, individuals can bring a family member or legal representative to the exam for support and to document the process.

Right to their own medical evidence

Your treating physician’s opinion remains extremely important. Even if the IME doctor minimizes your injury, your attorney can use medical records and testimony from your own doctors to counter the findings.

Preparing for an Independent Medical Examination

Preparation can make a difference in how your IME report is written and interpreted.

Steps to take before your IME

  • Review your medical history and be ready to explain your symptoms clearly and consistently
  • Bring a list of current medications and treatments
  • Arrive on time and cooperate respectfully during the exam
  • Avoid exaggerating or minimizing symptoms, as inconsistency can undermine credibility

Potential impact of the IME report

The IME doctor will issue a report summarizing findings, which may include:

  • Whether the injury is work-related or accident-related
  • Whether further treatment is necessary
  • The worker’s ability to return to work or restrictions that should apply

This report will be shared with the insurer and may be used in hearings or settlement negotiations.

How Pennsylvania Courts and Judges View IMEs

In Pennsylvania, workers’ compensation judges and trial courts evaluate IMEs alongside other medical evidence. While IMEs are influential, they are not automatically decisive. Judges often weigh:

  • Consistency between the IME findings and medical records
  • Whether the IME doctor spent adequate time reviewing the case
  • The qualifications and experience of both the IME physician and the treating physician
  • This balancing ensures that the insurer cannot rely solely on one opinion to terminate benefits or reduce a settlement.

Why IMEs Often Create Disputes

Disagreements over IME findings are common because insurers and injured individuals often have opposite goals. Insurers want to limit costs, while claimants want necessary medical care and fair compensation. This conflict makes the IME one of the most contested parts of a workers’ compensation or personal injury case.

Disputes may arise over:

  • Whether the injury is truly work-related
  • The need for ongoing medical care
  • The injured person’s ability to return to work
  • The permanence or severity of the impairment

When disputes arise, testimony from both the IME physician and the treating doctor may be presented at hearings, allowing a judge to make the final determination.

Protecting Yourself During the IME Process

Injured workers and plaintiffs can take proactive steps to ensure the IME does not unfairly damage their case.

Hire an experienced attorney

A lawyer can review IME notices, challenge improper requests, and cross-examine the IME physician if the case goes to hearing.

Document symptoms and treatment

Maintaining a consistent medical journal helps support your testimony if the IME report conflicts with your experience.

Know your rights

Being aware of Pennsylvania’s six-month rule for workers’ compensation IMEs and your ability to contest unreasonable requests can help you avoid intimidation during the process.

Conclusion

Independent Medical Examinations are a regular feature of Pennsylvania workers’ compensation and personal injury cases. They are required when insurers or defendants question the extent, cause, or duration of an injury. Although IMEs are arranged by the opposing side, their influence is balanced by the evidence provided by treating physicians and the oversight of judges. By understanding when IMEs are required, preparing carefully, and seeking legal guidance, injured individuals can protect their rights and ensure that medical evaluations do not unfairly reduce the benefits or compensation they deserve.

Need Legal Help? Brandon J. Broderick, Attorney at Law is One Phone Call Away

Navigating Workers Compensation and Personal Injury Claims can be challenging. Fortunately, you don't need to do it alone. The experienced lawyers at Brandon J. Broderick, Attorney at Law, are available 24/7 to help you understand your legal options, gather necessary evidence, and build a strong case to secure the settlement you deserve.

Contact us now for a free legal review.

Still have questions?

Call now and be done