Workers’ Comp: How an IME Can Affect Your Claim

After a work injury in Harrisburg, an IME can quickly shift control of your claim to the insurance company, giving them medical evidence to challenge it. If you go to this exam unprepared, even small mistakes could be used against you to limit the benefits you need.

What Is an IME in a Workers’ Comp Claim?

An Independent Medical Exam (IME) is a medical evaluation requested by the insurance company after a work injury.

A doctor chosen by the insurance company examines you, reviews your medical records, and submits a written report with their findings. That report can influence the direction of your entire workers’ comp claim.

Why Is the Insurance Company Requesting an IME After a Work Injury?

Insurance companies request an IME for one primary reason — to protect their financial interests. When you file a workers’ comp claim in Pennsylvania, the insurance company is responsible for covering your medical treatment and lost wages. An IME gives them a medical opinion they can use to question your injury, dispute your treating doctor’s findings, or build a case for reducing or ending your benefits. It is not a routine part of your medical care. It is a claims management tool.

Is the IME Doctor Really Independent?

No. Despite the word “independent” in the name, the doctor who conducts your IME is selected and paid by the insurance company. Many IME doctors perform these examinations regularly for insurance companies— it’s a significant part of their practice. The financial relationship alone raises legitimate questions about their objectivity. In Pennsylvania workers’ comp claims, it is not uncommon for an IME report to favor the insurance company’s position over your treating physician’s diagnosis and recommended treatment plan.

Could an IME Affect the Outcome of My Harrisburg Workers’ Comp Claim?

Yes. An unfavorable IME report can shift the entire direction of your workers’ comp claim in Pennsylvania.

IME Findings Allow Insurers to Challenge Your Claim

The insurance company can take the IME doctor’s findings directly to a workers’ comp judge to challenge your benefits. The impact can be immediate and significant.

An IME report may be used to question:

• Whether Your Injury Is Work-Related: The IME doctor may claim your condition existed before the workplace accident, giving the insurance company grounds to deny your claim entirely.
• The Severity of Your Injuries: If the IME report concludes your injuries are less serious than your treating physician says, the insurance company may use that finding to limit your medical coverage.
• Your Need for Ongoing Treatment: The IME report may recommend ending or reducing medical treatment your own doctor considers necessary for your recovery.

Your Workers’ Comp Benefits Can Get Reduced or Suspended

The insurance company may use the IME doctor’s findings to push for an early return to work — or light duty work. If successful, your wage loss and medical benefits may be reduced or suspended altogether.

Partially or Fully Disabled Workers Could Lose Key Benefits

For workers with severe injuries that leave them partially or fully disabled, the IME report may be used to argue that you are no longer totally disabled. If that argument is successful, you could lose a significant portion of the benefits you rely on.

Can I Refuse to Go to an IME in Pennsylvania?

No. Under Pennsylvania workers’ compensation law, you are required to attend an IME when the insurance company requests one. Refusing to go — or simply not showing up — can seriously damage your Harrisburg workers’ comp claim. It could even cause your benefits to be suspended.

Having to attend an IME does not mean, however, that the insurance company’s right to request an IME is unlimited. Pennsylvania law places certain restrictions on how and when an IME can be scheduled. If you have concerns about your IME, the right move is to speak with a Harrisburg workers’ comp attorney before the exam — not to skip it.

An attorney can help you understand your legal options in this situation and help you understand and prepare for the IME.

Preparing for an IME: What Injured Pennsylvania Workers Need to Know

How you prepare for your IME is as important as the medical exam itself. The IME doctor will observe everything from the moment you approach and enter their office. This includes what you wear, how you walk into the room, how you move/sit, and how you describe your symptoms.

Not understanding the purpose and going in unprepared can result in a medical report that doesn’t accurately reflect your condition or the impact your work injury has had on your life.

Before your IME, make sure you:

Review Your Medical History

You’d be surprised how much of the factual details you forget even a short time after your initial injury. Take some time to review your records, your diagnosis, and your treatment history. You need to be able to recall details so you can speak clearly and consistently about your injury and symptoms.

Bring a Written Summary of Your Symptoms

Bring a written, simple, factual account of your injury, symptoms, and limitations. You can refer to your notes to help you stay focused and consistent during the exam.

Critical Mistakes to Avoid When Getting an IME in Pennsylvania

Even small mistakes during your IME can have a big impact on your Harrisburg workers’ comp claim. Be aware of these common missteps before you walk through that door.

• Arriving Late to Your Appointment: Being late — or worse being a “no show” — makes you appear uncooperative. Either situation could cause your benefits to be paused or terminated. As with any doctor’s appointment, problems can arise — but call to let them know and reschedule your appointment.
• Forgetting the Exam Begins in the Parking Lot: Insurance companies may conduct surveillance around IME appointments. How you move and behave before and after the exam may be observed and documented.
• Wearing Inappropriate Clothes: Not dressing appropriately — such as wearing heels when you claim to have leg or back pain — is going to hurt your claim. Don’t “put on a show” but wear clothes that are appropriate, neat, and easy to move in.
• Downplaying Your Pain: Many injured workers minimize their symptoms without realizing it. This is as bad as exaggerating your pain. It could result in an IME report that understates the severity of your injury.
• Being Unprepared to Describe Your Symptoms: Vague or inconsistent answers give the IME doctor room to question the legitimacy of your injury. You know your symptoms, but you must also be ready to describe them clearly.
• Volunteering Too Much Information: Be courteous and answer the questions asked — nothing more. Don’t ramble or get into casual conversation. Anything you say can be taken out of context and used against you.
• Discussing Your Claim or Legal Strategy: Do not mention your attorney, your case strategy, or your intentions at all. The exam is medical — keep it that way.

What to Expect During a Workers’ Comp IME Exam

A workers’ comp IME is typically much shorter than a visit with your own doctor — and very different in purpose. Knowing what to expect before you go can help you stay calm, focused, and consistent throughout the exam.

You can generally expect:

• General Observation: The IME doctor will observe how you move naturally with your injuries.
• Review of your Medical Records: The doctor will review your file and ask questions about your medical history, the accident and resulting injuries, and any pre-existing injuries you may have had.
• Questions About Your Job Duties: Expect some questions about your physical work demands.
• A Brief Physical Exam: The IME doctor will examine you, and conduct range-of-motion and general strength testing.
• No Treatment or Medical Advice: Unlike appointments with your treating physician, the IME doctor is just gathering information. They are not there to treat you.

What Happens to Your Medical Report After the IME

After your exam, the IME doctor submits their findings in a written report directly to the insurance company. From there, the insurance company shares this report with their legal team. The findings in this report will be used to determine their next move on your claim.

You are entitled to a copy of that report — be sure to review it carefully and discuss it with your attorney. The findings in that document can be presented as evidence before a Pennsylvania workers’ compensation judge.

How Our Law Firm Helps You Navigate the IME Process

At Schmidt Kramer, we know how much is at stake when an insurance company schedules an IME. We prepare our clients thoroughly and work to ensure the process is handled fairly. An unfavorable IME report doesn’t have to be the final word on your Harrisburg workers’ comp claim.

We can help you by:

• Preparing You for the Exam: We walk you through what to expect, what to say, and what to avoid.
• Reviewing the IME Report: We compare the findings against your treating physician’s records to identify inconsistencies.
• Challenging Unfavorable Findings: We present your treating doctor’s opinion and supporting medical evidence to counter a biased report.
• Protecting Your Benefits: If the insurance company moves to reduce or terminate your benefits based on the IME, we act quickly to defend your claim.
• Keeping You Informed: We explain every development in plain language — you always know where your claim stands.

FAQs About Independent Medical Exams in PA Workers’ Comp Claims

Do I have to go to an IME for a workers’ comp claim?

Yes. Pennsylvania workers’ compensation law requires you to attend an IME when the insurance company requests one. Refusing to go can result in suspension of your benefits.

Are IMEs always required after a work injury?

No. The insurance company decides whether to request an IME, and they typically do so when they want to challenge your injury, your treatment, or your ability to work.

Is an IME a second opinion for workers’ comp claims?

No. A second opinion is sought in your interest. An IME is requested and paid for by the insurance company to serve their interests — not yours.

What happens if I skip my workers’ comp IME in Pennsylvania?

Your benefits can be suspended. Missing an IME without a valid legal reason gives the insurance company grounds to stop paying your wage loss and medical benefits until you comply.

Can I bring a friend or family member to my workers’ comp IME?

Yes. Pennsylvania law allows you to bring someone with you to observe the exam. Having a witness present can be valuable if the IME report is later disputed.

What if the IME doctor disagrees with my doctor’s diagnosis or treatment?

Your treating physician’s opinion does not automatically lose. A workers’ comp judge weighs both opinions and considers the full medical record. An experienced attorney can present your doctor’s findings effectively to counter an unfavorable IME report.

Is the Insurance Company Disputing Your Work Injuries? Call Schmidt Kramer Today

An IME is one of the most powerful tools an insurance company has to challenge your workers’ comp benefits in Pennsylvania. But it is not the final word — not when you have experienced legal representation standing between you and an unfair outcome.

At Schmidt Kramer, our skilled legal team works tirelessly to protect the claims and benefits of injured workers throughout Harrisburg. If the IME report doesn’t tell the full story of your injury, we know how to challenge it — we don’t cave when the insurance company tries to push back.

Worried about the cost of hiring a lawyer? Don’t be. We take workers’ compensation cases on contingency. This means there are no upfront attorney fees and no out-of-pocket costs to pay. We only get paid if you do.

Call Our Harrisburg law firm today at (717) 888-8888
Your benefits and recovery are too important to leave to chance.