An Independent Medical Examination (IME) is a medical evaluation scheduled by the insurance company, with a doctor who is not your treating physician. The purpose of an IME is for the insurer to obtain an “independent” medical opinion regarding your work injury. In practice, insurers often use IMEs to clarify questions about your diagnosis, treatment, work restrictions, or to see if your condition is really work-related. Many injured workers feel anxious about IMEs – will the IME doctor side with the insurance company? This section explains your rights and responsibilities surrounding IMEs in Oregon.
Why and When IMEs Happen
It’s fairly routine for an insurer to request an IME at some point in a claim, especially if there are unresolved issues. For example, they might question whether a certain treatment is necessary, or whether some of your medical conditions are actually due to the work injury versus preexisting issues. They might also use an IME to determine if you have become medically stationary (i.e., ready for claim closure). Generally, insurers schedule an IME to address specific questions such as causation of your condition, whether the current treatment plan is appropriate, what your work limitations are, or whether you’ve healed enough to return to work[81]. The IME doctor will examine you and review your medical records, then write a report answering the insurer’s questions.
Your Obligation to Attend
Under Oregon law, you must attend a properly noticed IME. If you refuse or just don’t show up, the insurer can petition to have your workers’ comp benefits suspended until you comply[82]. In fact, failing to attend without a valid reason can lead to termination of benefits, so it’s taken seriously[82]. However, the law also provides some safeguards for workers:
- The insurer must give you at least 10 days’ advance written notice of the IME appointment, including the date, time, place, and the doctor’s name and specialty[83][84].
- You have the right to have a friend or family member accompany you to the exam (though they might not be allowed in the room for certain parts).
- If you absolutely cannot attend at that time (e.g., you’re scheduled for surgery that day or out of town), you should contact the adjuster immediately to reschedule. Don’t just no-show; communication can usually resolve scheduling conflicts[85].
While you must attend the exam, you are not required to undergo invasive procedures during an IME without consent[86]. For instance, if an IME doctor wanted to do an injection or something more than an exam, you could decline and your benefits can’t be cut for that reason[87]. But such invasive requests are uncommon in IMEs, which usually consist of an interview and physical examination.
Limits on Number of IMEs
Oregon law prevents insurers from sending you to endless IMEs. Generally, the insurer can require up to 3 IMEs per claim (while the claim is open) without special permission[88][86]. If they want more than three, they’d need approval from the Workers’ Compensation Division. Also, if they schedule a “panel” IME (where multiple specialists see you in one trip), that counts as one IME[89]. This limitation protects you from harassment by excessive examinations. Most claims involve 0-2 IMEs; only in complex cases might they approach the limit of three.
Expenses and Reimbursement
The insurer has to cover the costs associated with attending the IME. That includes mileage or public transportation fare, meals and lodging if you have to travel far, and even lost wages if you miss work for the exam[90][91]. In practice, they often mail you a mileage check or provide a form (Form 3921) to request reimbursement[92][93]. Keep receipts if you incur costs like a hotel or child care because those can be reimbursed too[94][95]. The key is to submit the reimbursement request in writing, with documentation.
If traveling to the assigned IME location is a hardship (for example, it’s very far and you have a medical condition that makes travel difficult), you can object to the location. Contact the Workers’ Compensation Division within 6 business days of the mailing date of your appointment notice to challenge the exam location. They will review and can order a more reasonable location if your objection is valid[96].
After the IME: What It Means for Your Claim
Once the IME is done, the doctor will send a report to the insurance adjuster. You and your attorney (if you have one) should get a copy as well. If the IME agrees with your treating doctor, then nothing much changes. If the IME doctor’s opinion differs, the insurer might try to use it to make decisions on your claim – for instance, to deny a certain medical treatment, or even to deny the claim outright if the IME says your condition isn’t work-related.
You are allowed (and encouraged) to discuss the IME report with your own doctor. Often, your treating physician will be asked to “concur” with the IME or not. If your doctor disagrees with the IME’s conclusions, that needs to be made clear in writing. Insurers tend to favor IME opinions, but the Workers’ Compensation Division or a judge will consider both your doctor’s and the IME’s opinions if there’s a dispute.
What if an IME leads to a denial? Suppose the insurer denies your claim (or a part of it) based on an IME opinion. Oregon has a remedy: if your attending physician does not agree with the IME, and the claim is denied, you can request a Worker Requested Medical Exam (WRME)[97][98]. This is essentially a second independent exam by a doctor chosen by the Workers’ Compensation Division (not by the insurer) to get another opinion. You must have an active appeal of the denial (requested a hearing) to qualify. The WRME can provide an unbiased assessment to counter a potentially biased IME. The results of a WRME can be used as evidence in your appeal[99][100].
In summary, an IME is something most claimants will encounter. Cooperate and attend the exam, know that you can be reimbursed for costs, and don’t be intimidated. It’s one doctor’s opinion. If it ends up unfriendly to your claim, you have ways to challenge it with your own medical evidence and even a WRME. Staying informed and having an experienced workers’ comp attorney can ensure that an IME doesn’t unjustly derail your benefits.