Independent medical examination
A one-hour examination by a physician who will never treat the patient is a different kind of document from a treatment record. Both kinds have limits, and both get overstated.
An independent medical examination (IME) is an examination by a physician who will never treat the patient, commissioned by either side. It brings a fresh look and the full records at once, but it lacks time, longitudinal observation and any test of whether an explanation survives treatment.
Independent examinations follow a small number of predictable patterns, whoever commissions them. Each pattern has a specific answer, and the answer is almost always evidence rather than rhetoric — which is why it has to exist in the chart before any report arrives.
What do IME reports usually argue, and what answers each point?
ONE — THE IMAGING IS THE DIAGNOSIS
The report recites degenerative findings and attributes the pain to them. Answered with the asymptomatic-population data and with level-by-level correlation to the exam — see pre-existing degeneration.
TWO — SYMPTOMS OUT OF PROPORTION
Usually asserted, rarely measured. Answered with objective corroboration: an electrodiagnostic finding, a documented block response, quantitative sensory thresholds.
THREE — THE HEALING TIMETABLE
Soft tissue resolves in six to twelve weeks, therefore this is not injury-related. Answered by asking which population the timetable describes — see metabolic dysfunction and injury.
FOUR — THE TREATMENT GAP
Answered with a contemporaneous record of why the gap existed, which has to have been taken at the time rather than reconstructed later.
FIVE — NON-ORGANIC SIGNS
A handful of examination signs get presented as detecting exaggeration. They were not designed for that purpose, they are not validated as lie detectors, and a positive finding is not a finding of malingering. The reply is to ask what the sign was validated to detect.
Is an IME more reliable than the treating doctor’s record?
THE TREATING RECORD
Has: longitudinal observation across many visits, a response to treatment that either happened or did not, entries made before anyone knew which findings would matter. Lacks: independence. The treating physician heard the history from one person and has a relationship with them.
THE INDEPENDENT EXAMINATION
Has: a fresh look, the full records at once, and no therapeutic relationship to protect. Lacks: time, longitudinal observation, and any test of whether a proposed explanation survives contact with treatment.
Neither is inherently the better document, and a practice that always says otherwise is telling you which side it is on. What matters is which one addressed the question with evidence.
Does this practice perform independent medical examinations?
This practice performs independent examinations and record reviews on request from either side — see independent case review — and comments on another examiner’s medical assertions where it has treated the patient and has a basis. It does not write reports whose conclusion is agreed in advance, in either direction, and where an examiner’s reasoning is sound it says so, including when that is inconvenient for whoever asked.
This practice is not aligned to a side. Its obligation runs to the patient’s health and safety, which is the same reason it is not beholden to any position that would keep it from seeing what is actually there. We do not offer opinions on liability, we do not accept a referral or a review conditioned on reaching a particular conclusion, and we will say plainly when the evidence does not support the claim — whichever party was hoping otherwise.
Frequently asked questions
Will you respond to an examination report?
We will address specific medical assertions in it where we have treated the patient and have a basis. We will not write a response to order, and we will not characterize the examiner.
Are non-organic signs evidence of malingering?
No. They were described to identify patients whose presentation is not purely structural, which is not the same as feigning — and are frequently presented as though it were.
Do you perform examinations for carriers and defense firms?
Yes. See independent case review for the terms, which are the same in both directions.
Does a short examination invalidate the report?
No, and arguing that alone is weak. What answers a report is contrary evidence, not the length of the appointment.
What is the purpose of an IME?
An IME gives a claim a physician’s examination from someone who will never treat the patient, commissioned by either side. It brings a fresh look, the full records at once and no therapeutic relationship to protect. What it lacks is time, observation across many visits, and any test of whether its explanation survives treatment — which is what the treating record supplies.
Is an IME a second opinion?
Not in the treating sense. The examining physician will never treat the patient, so the result is a report, not a plan of care. It is a different kind of document from a treatment record: one examination set against a record built across many visits. Neither is inherently the better document; what matters is which one answered the question with evidence.
How long does an IME typically take?
The examination itself is typically about an hour. That length alone does not invalidate the report, and arguing that it does is weak. What answers an IME is contrary evidence: level-by-level correlation of the imaging to the exam, objective corroboration such as an electrodiagnostic finding or a documented block response, and a contemporaneous record of why any treatment gap existed.
Related reading
- Records that survive cross
- Objective corroboration
- “Pre-existing degeneration”
- Effort and validity testing
- Expert testimony
Send the report and the records it relied on
Most of what an examination report asserts is answerable with evidence that already exists or could be generated. We will tell you which.
12166 Natural Bridge Rd
St. Louis, MO 63044
Monday to Friday, 8:00 a.m. to 5:00 p.m. Nothing on this page is legal advice, and nothing on it is medical advice.
Sources
- Brinjikji W et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 2015. PubMed 25430861
- Raja SN et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, 2020. PubMed 32694387
- Johnson-Greene D et al. Relationship between performance validity testing, disability status, and somatic complaints. The Clinical Neuropsychologist, 2013. PubMed 23121595
- Cohen SP et al. Multicenter, randomized, comparative cost-effectiveness study comparing 0, 1, and 2 diagnostic medial branch block treatment paradigms before lumbar facet radiofrequency denervation. Anesthesiology, 2010. PubMed 20613471