Receiving notice of an independent medical exam (IME) can leave you wondering what happens next and how the appointment might affect your claim in Vermont.
An IME is a medical evaluation requested as part of the claims process. The physician performing the exam is asked to provide an independent opinion about issues such as your diagnosis, work restrictions, recovery, or the cause of your injury. The appointment is not intended to replace treatment from your doctor.
For many people, the uncertainty is the hardest part. You may be concerned about the questions you'll be asked, whether you have to attend, or what the doctor will include in the report. In this guide, we explain what to expect during an independent medical exam in Vermont, why an IME may be required, how the process works, and what steps may help you prepare before the appointment.
Key Takeaways: What to Expect During an Independent Medical Exam in Vermont
- An independent medical exam evaluates medical issues related to your claim and generally is not intended to provide treatment.
- Vermont law allows employers or insurers to request an IME in certain workers' compensation claims and gives injured workers specific rights during the examination.
- The examining physician may review your medical records, discuss your symptoms, perform a physical examination, and prepare a report used during the claims process.
- During an employer-requested examination under 21 V.S.A. § 655, an injured worker may make a video or audio recording of the examination or have a licensed healthcare provider, designated and paid by the worker, present. Vermont's Workers' Compensation Rules impose additional notice and procedural requirements when a worker intends to record the examination.
- Preparing for the appointment by reviewing your medical history and answering questions honestly can help the examination accurately reflect your condition.
What Is an Independent Medical Exam in Vermont?
An independent medical exam (IME) is a medical evaluation used to assess issues related to an injury claim. The exam is usually performed by a physician selected by the employer or insurance company. In some Vermont workers' compensation disputes, the examiner is appointed by the Department of Labor. The physician evaluates your condition and prepares a medical opinion but generally does not become your treating doctor.
An IME may be requested after a workplace injury for several reasons. The employer or insurer may seek another medical opinion about:
- The nature and extent of the injury,
- The need for additional medical treatment,
- Your ability to return to work,
- Work restrictions,
- Maximum medical improvement (MMI), or
- Permanent impairment.
The Commissioner of Labor may appoint an independent medical examiner when a dispute exists concerning the reasonableness or necessity of treatment, the claimant's ability to perform suitable work, or another medical issue. If a dispute over permanent partial impairment involves disability ratings that differ by more than 10 percent, the Commissioner must appoint an independent medical examiner; if the ratings differ by 10 percent or less, the Commissioner determines the rating.
After an injury and during the period of disability, 21 V.S.A. § 655 requires an employee, when requested by the employer or ordered by the Commissioner, to submit at reasonable times to an examination by a duly licensed physician or surgeon designated and paid by the employer. The statute also includes important protections for injured workers.
An employer-requested IME under 21 V.S.A. § 655 must be conducted within a two-hour driving radius of the injured worker's residence. The Commissioner may permit an examination outside that radius when the circumstances permitted by Vermont law and the Workers' Compensation Rules are satisfied, including when specialized expertise is required. Workers also have the right to make a video or audio recording of the examination or have a licensed healthcare provider designated and paid by the worker present.
The IME report is one part of the claims process. Decision-makers generally consider it together with your medical records, your treating physician's opinions, and other relevant evidence.
Why Insurance Companies Request IMEs
An independent medical exam is typically requested when an employer or insurance company needs additional medical information to evaluate a workers' compensation claim. The examination helps answer questions about your injury, recovery, work capacity, or other medical issues that could affect the claim.
An employer or insurer may request an IME to obtain another medical opinion about:
- The diagnosis or extent of your injury,
- The need for ongoing medical treatment,
- Temporary or permanent work restrictions,
- Your ability to return to work,
- Whether you've reached maximum medical improvement (MMI), or
- The degree of any permanent impairment.
Some claims move forward without disagreement between doctors. Others involve conflicting medical opinions or questions about the cause of an injury, recovery timeline, or future treatment. An IME provides the requesting party another physician's assessment of those issues.
Under 21 V.S.A. § 667, the Commissioner may appoint an independent medical examiner when specified medical disputes arise. If a permanent partial impairment dispute involves disability ratings that differ by more than 10 percent, however, the Commissioner must appoint an independent medical examiner. The examiner's opinion regarding the degree of impairment is binding on the parties unless there is substantial error or omissions, fraud, or a gross departure from generally accepted medical practices.
The purpose of an IME depends on who requested it. An employer-requested examination under 21 V.S.A. § 655 helps the employer or insurer evaluate the claim. A Commissioner-appointed IME under 21 V.S.A. § 667 serves a different function by helping resolve specific medical disputes that arise during the workers' compensation process.
Knowing which type of examination has been scheduled can help you understand what to expect and how the report will be used. If you're unsure why an IME was requested or what it means for your claim, an attorney can help you understand the process and your options.
What to Expect During the Exam
Most independent medical exams follow a similar format, although the length and scope of the appointment depend on the injury being evaluated. Some examinations take less than an hour, and others may take longer if the physician reviews extensive medical records or evaluates multiple injuries.
A typical IME may include:
- Completing intake paperwork,
- Discussing how the injury occurred,
- Reviewing your medical history,
- Answering questions about your symptoms and daily activities,
- A physical examination related to the reported injury, and
- Review of relevant medical records and diagnostic imaging.
During the exam, you'll likely answer questions about your injury, symptoms, daily activities, and ability to work. The physician may also evaluate your range of motion, strength, reflexes, or mobility and compare those findings with your medical records. Answering questions honestly and consistently can help provide an accurate picture of your condition.
Employer-requested IMEs in Vermont are also subject to procedural protections. Except in exigent circumstances, the Vermont Department of Labor's Workers' Compensation Rules require written notice of an employer- or insurer-requested IME at least seven days before the scheduled examination. The notice must identify the reasons for the examination and the issues to be addressed and must include information concerning the injured worker's and examining provider's rights and responsibilities regarding video and audio recording.
After the appointment, the physician prepares a written report summarizing the examination and medical opinions. Depending on the purpose of the IME, the report may discuss your diagnosis, ability to work, treatment needs, permanent impairment, or whether you've reached maximum medical improvement. The report then becomes part of the medical evidence used to evaluate your claim.
Can an IME Hurt Your Injury Claim?
An independent medical exam can influence your workers' compensation claim because the physician's findings become part of the medical evidence used to evaluate disputed issues. Even so, the report does not automatically determine the outcome of your case.
The examining physician's opinions may differ from those of your treating doctor. For example, the IME doctor may conclude that:
- Your injury has healed more than expected
- Additional treatment is no longer medically necessary
- You can safely return to work
- Work restrictions should be changed, or
- Your level of permanent impairment differs from another physician's assessment.
When medical opinions conflict, decision-makers typically review the entire record instead of relying on a single report. Medical records, diagnostic imaging, treatment history, and opinions from other healthcare providers may all be considered alongside the IME findings.
Some claims require additional review, especially when doctors disagree about permanent impairment or other important medical issues. How much weight an IME carries depends on the reason for the examination and the specific questions involved.
The exam is also your chance to give an accurate picture of your condition. Answer questions honestly, describe your symptoms as they are on the day of the exam, and don't guess whether you can't remember a date or detail. Clear, consistent answers help the physician complete an accurate evaluation.
How to Prepare for an Independent Medical Exam
Preparing for an IME is less about having the "right" answers and more about arriving ready to discuss your medical condition accurately. A little preparation can help you feel more comfortable and reduce the stress that often comes with an unfamiliar medical appointment.
Before the examination, consider:
- Reviewing the timeline of your injury and treatment
- Making a list of your current medications
- Refreshing your memory about your job duties if the injury is work-related
- Bringing any documents requested in your appointment notice
- Arriving early to complete paperwork, and
- Wearing clothing that allows the physician to examine the injured area, if appropriate.
During the appointment, listen carefully to each question before answering. If you don't understand something, please ask the physician to explain it. If you cannot remember a specific date or event, it's perfectly acceptable to say so rather than estimate.
Many people also find it helpful to write down what occurred during the examination after they leave the office. Notes about the length of the appointment, the tests performed, and the topics discussed may help refresh your memory if questions arise later.
What to Do After You Receive the IME Report
Once the examination is complete, the physician prepares a written report summarizing the evaluation and medical opinions. In most cases, the report is sent to the party that requested the IME and becomes part of the claim file.
Depending on the purpose of the examination, the report may discuss:
- The physician's diagnosis
- Your current medical condition
- Recommended work restrictions
- Future treatment needs
- Maximum medical improvement (MMI)
- Permanent impairment
Receiving the report does not mean your claim is over. The findings may be reviewed alongside your treating physician's records, diagnostic tests, and other medical evidence before decisions are made about disputed issues.
If you have questions about the report, reviewing it carefully can help you identify any factual errors or statements that do not accurately reflect your medical history or the examination itself. Keeping copies of your medical records, appointment notes, and other claim documents may also make it easier to discuss the report with your treating physician or attorney.
Frequently Asked Questions:
Can I Refuse to Attend an Independent Medical Exam in Vermont?
For an employer-requested examination under 21 V.S.A. § 655, refusing without good cause to attend or obstructing the examination can suspend your right to prosecute a workers' compensation proceeding, and compensation is not payable while the refusal or obstruction continues. For a commissioner-appointed examination under § 667, a failure or refusal without good cause may result in assessment of examination or missed-appointment costs, suspension of compensation, or both. If you cannot attend as scheduled, notify the employer or insurer promptly and follow the procedures in Vermont's Workers' Compensation Rules.
Will the IME Doctor Treat My Injury?
No. An independent medical exam is performed to evaluate medical issues related to your claim. The examining physician generally does not become your treating doctor or provide ongoing medical care.
How Long Does an Independent Medical Exam Take?
There is no standard length for every IME. Some appointments take less than an hour, while others may last longer depending on the injury, the medical records being reviewed, and the purpose of the examination.
What if the IME Doctor Disagrees With My Treating Physician?
Different physicians sometimes reach different conclusions based on their examinations and review of the medical records. If opinions conflict, the report is generally considered along with other medical evidence before disputed issues are resolved.
Can I Bring Someone With Me to the Examination?
For an employer-requested examination under 21 V.S.A. § 655, an injured worker may make a video or audio recording or have a licensed healthcare provider designated and paid by the worker present. Vermont's Workers' Compensation Rules require an injured worker who intends to make a video or audio recording to give the employer or insurer notice at least three business days before the examination.
Brandon J. Broderick, Attorney at Law, Can Help You Prepare for an Independent Medical Exam
An independent medical exam can feel like an important turning point in a workers' compensation claim, especially if you're unsure why the examination was requested or how the physician's opinions may be used. Knowing what to expect before the appointment can help you approach the process with greater confidence and avoid unnecessary surprises.
If you have questions about an upcoming IME, concerns about the examination process, or uncertainty about how the report may affect your claim, Brandon J. Broderick, Attorney at Law, can review your situation, explain how Vermont workers' compensation law applies, and help you understand the options available.
Contact our office today, and let's help to make sense of the IME process together.