You went to the appointment the insurance company scheduled. A doctor you had never met asked some questions, examined you briefly, and sent you home. Now you are waiting, and you may be wondering what that doctor will write and whether it could change your benefits.
An Independent Medical Examination, or IME, is an exam by a doctor your employer or its insurer chooses and pays for. In a Virginia workers’ compensation claim, the IME report can carry real weight. It does not automatically decide your case, and you have rights before, during, and after the exam. At Mark Hurt Law Firm, we help injured workers throughout Southwest Virginia understand what an IME report may mean for their claim and what they can do next.
Under Va. Code § 65.2-607, as long as you are claiming compensation, your employer can ask you to be examined by a qualified physician it designates and pays for, at reasonable times and places. The Virginia Workers’ Compensation Commission can also order an exam.
Insurers often request an IME when they want another opinion on questions such as:
The law also sets limits. An employer generally cannot obtain more than one exam per medical field without prior permission from the Commission, which requires a showing of good cause or necessity.
A little preparation can help the exam reflect your actual condition.
Do not skip the appointment. If you refuse or obstruct an exam your employer requested, your right to compensation can be suspended until you comply. You generally will not be paid for that period unless the Commission finds the refusal was justified. If the time or location is a genuine problem, ask in writing to reschedule.
The IME doctor is not your treating physician. They are there to evaluate you, not to treat you or prescribe care. Under Virginia law, what you tell this doctor is not privileged, which means it may be used in a Commission hearing.
Be honest and consistent. Describe your symptoms as they really are, without downplaying or exaggerating them. Explain how the injury affects ordinary tasks like lifting, sitting, sleeping, or driving, and mention every body part that was hurt. When you get home, write down when you arrived, how long the doctor spent with you, and which tests were performed.
The doctor reviews your records and exam findings, then answers the questions the insurer asked. How long this takes varies from case to case.
The Commission’s rules require each party to promptly share medical records it receives with the other parties. If you have an attorney, the report usually goes to them. Read it carefully for errors, such as the wrong injury date, missing symptoms, or an inaccurate description of your job.
Depending on what the report says, the insurer may continue benefits as they are, deny a pending treatment request, or try to change your benefits through the Commission.
If you are receiving benefits under an open Award, your employer generally must file an Employer’s Application for Hearing with supporting documentation to suspend or terminate them. Compensation generally must be paid through the date the application is filed. You then have 15 days to respond with evidence, and the Commission decides whether benefits should be suspended while the dispute is pending. Do not ignore mail from the Commission.
Virginia courts have long held that when a treating physician is positive in their diagnosis, that opinion is generally given great weight. The Commission is still the fact finder, though, and it is not required to accept the treating doctor’s view over an IME doctor’s. That is why your treating doctor’s records matter. If your doctor disagrees with the IME report, ask whether they will review it and respond in writing.
Under Va. Code § 65.2-606, either party can ask the Commission to appoint a disinterested physician to examine you, and the Commission can also do this on its own. The Commonwealth pays that physician’s fees. Whether this step helps depends on the medical dispute and the status of your claim.
The doctor is usually chosen and paid by your employer or its insurer. The doctor may be fair, but the exam is requested by one side of the claim. The Commission weighs the report along with your treating doctor’s records and the rest of the evidence.
Virginia law gives you the right to have a qualified physician of your choosing present, at your own expense. Whether a family member or other companion can be in the room may vary. Ask your attorney before the appointment.
Generally, an employer is limited to one exam per medical field unless the Commission authorizes another based on good cause or necessity. An exam in a different field, such as neurology after orthopedics, may be treated differently.
Wage-loss benefits under an open Award generally do not end just because of the report. The employer must use the applicable Commission procedure. Talk with your treating doctor and read our guide on what happens when your doctor releases you to return to work.
No. Virginia law states the examining physician is designated and paid by the employer or the Commission. If you choose to bring your own physician, that cost is yours.
An IME report may affect your income, your medical care, and the direction of your claim. If the report gets your history wrong, conflicts with your treating doctor, or has led to a change in your benefits, a Virginia workers’ compensation lawyer can review it and explain the procedures that may apply.
We represent workers’ compensation clients on a contingency-fee basis, meaning attorney fees are owed only if the firm secures benefits or compensation, subject to the fee terms and Commission approval that apply to the representation.
Contact Mark Hurt Law Firm for a free consultation. We can review your IME report, medical records, and Award Order and explain the options that may be available under Virginia law.
