Independent Medical Examination (IME) Explained: Washington L&I Claims

The results of an IME can affect whether you are eligible for benefits, including permanent partial disability (PPD) awards. Here, the Washington workers’ comp attorneys at Lehmbecker Law provide a comprehensive overview of IMEs, including what to expect, how they are conducted, and how they might affect your claim.

What Is an IME?

An IME is a medical evaluation conducted by an impartial examiner. Physicians who conduct IMEs must qualify through the Washington State Department of Labor & Industries (L&I).

Your examiner will not be affiliated with your treating doctor, your employer, or any workers’ comp insurer. Their goal is to provide an objective assessment of your injuries and their impact on your ability to work in the context of a workers’ compensation claim.

IMEs are often used to determine whether an employee's injuries are work-related and to assess the extent of their disability.

When Can an IME Be Requested?

Either L&I or a self-insured employer can request an IME to clarify and establish findings about an injured worker’s medical condition. Some common reasons for requesting this exam include:

• Progress checks: IMEs may be ordered at different stages of the claim, such as after initial medical treatment or after a new medical problem appears.
• Disputes or inconsistencies: An IME may be requested to resolve inconsistencies between the injured worker's medical records and the employer's account of the injury.
• Claim appeals: If L&I denies a claim, an IME may be conducted during the appeal.
• Impairment rating: An examiner can be called upon to assign an impairment rating for a PPD award.
• Work restrictions: IMEs can be used to confirm whether an employee can return to work and in what capacity.

You can file a dispute at any time during the process. You also have the right to record audio or video of the independent medical exam, but you must notify the provider before you do this. Additionally, you may be able to challenge the report in court if you believe it is unfair or inaccurate.

Who Takes Part in the IME Doctors Selection Process?

A doctor must take a test and apply through L&I to become an IME provider. L&I also conducts ongoing training and continuing education for these providers.

L&I (or the injured worker’s employer, if self-insured) can order an IME at certain stages in the workers’ compensation process. The organization must provide the worker with sufficient notice before scheduling the exam.

How Do I Schedule an Independent Medical Exam in Washington?

L&I provides a list of qualified examiners on its website. To schedule an independent medical examination as an employer, you should reach out to your workers’ compensation insurance partner. If you have concerns or preferences, discuss them with your insurance carrier or L&I.

If you are an injured worker in Washington, you will probably not schedule your own IME. However, you have the right to dispute an IME scheduled by someone else. Some reasons for filing a dispute include:

• The location of the exam is unreasonably inconvenient
• You were not given sufficient notice for the exam
• The grounds for the IME request are not valid

Missing an IME appointment can set back your workers’ compensation case or even lead to a denial. Before the exam, you should confirm the date, time, and location, along with any specific instructions from the provider.

How Do I Prepare for an IME?

The examiner might have questions for you, so a little preparation can help the IME go more smoothly. Consider taking these steps:

• Gather medical records: Collect all relevant medical records, including doctor's notes, test results, and treatment plans.
• Document your symptoms: Keep a detailed journal of your symptoms, including their frequency, their severity, and any activities that exacerbate or alleviate them.
• Prepare questions: Write down any questions you have for the examiner.
• Understand your rights: Familiarize yourself with your rights, including the right to record the exam and the right to bring an observer.
• Be honest and consistent: Don’t exaggerate your injuries and symptoms, but don’t downplay them, either; if something hurts, tell the examiner.
• Dress appropriately: Dress comfortably and appropriately for the type of examination you expect.
• Follow instructions: Carefully follow any instructions provided by the insurer or L&I regarding the process.

The more information the examiner has, the more accurately they can assess your injury and determine its impact on your life.

What Does an IME Report Reveal?

The IME report is crucial to your workers’ compensation case. It will provide a detailed assessment of your medical condition, including:

• Diagnosis: The specific injury or illness in question.
• Functional limitations: The physical and mental limitations that the injury has imposed on you, including how it affects your work and daily life.
• Impairment rating: A numerical value that reflects the extent of any permanent disability and is used to determine a PPD award.

You can expect a comprehensive report that provides detailed information about your condition and your ability to function.

What Should I Do After My IME?

After receiving the results of your IME, you should:

• Carefully review the report.
• Discuss the report with your workers' comp attorney.
• If necessary, work with your attorney to gather additional medical evidence or documentation to support your claim.

If you and your attorney agree with the findings in the report, it may be time to resolve your claim.

How Much Can I Receive from L&I Workers' Comp After My IME?

The following factors could affect the value of your L&I workers’ compensation claim:

• Wage loss: You should be reimbursed for a portion of your lost wages while you are unable to work.
• Medical expenses: All medical treatment related to the injury should be paid for.
• State-specific laws: Your Washington workers’ compensation lawyer can explain how changes to state laws may affect your claim.
• PPD impairment rating: The IME will assign a rating to any permanent physical impairment to determine your PPD award.

Many IMEs are conducted to determine whether the worker has reached maximum medical improvement (MMI). This means that the worker's condition has stabilized and that they are unlikely to improve further with additional medical treatment. Once an injured employee reaches MMI, they may be eligible for a PPD award.

At Lehmbecker Law, We Have Answers to Your Questions About IMEs

It’s important to understand what will happen before, during, and after an independent medical examination — this exam could be a critical turning point in your workers’ compensation claim.

When you need personalized legal guidance, the attorneys at Lehmbecker Law can help. Contact us for a free consultation.