How to Challenge an Independent Medical Examiner’s Report

January 16, 2025
Stern & Cohen
independent medical exam IME

A crucial aspect of your workers’ compensation claim involves attending an evaluation conducted by an Independent Medical Examiner (IME). The IME is significant for both claimants and employers.

In Pennsylvania, an employer must present medical evidence, typically through an IME conducted by a company-paid physician, to prove you are fully recovered from your work injury and cease compensation. However, the IME’s opinion can either support or harm your case. If you disagree with the IME’s findings, there are several options your attorney can pursue.

Ways to Challenge an IME’s Opinion

The first route your attorney may take is to argue in court that the IME’s opinion is not competent or lacks a sufficient basis. If discrepancies exist in the IME’s findings, your attorney can address this through various means, such as cross-examining the IME doctor, presenting expert testimony to refute the findings, or submitting a legal argument in a brief to the judge. However, a medical expert’s opinion is deemed incompetent only if it is based on inaccurate or false information. To evaluate the credibility of an IME, the court will consider:

  1. The reasoning as a whole
  2. Whether the credibility determination is arbitrary, capricious, or fundamentally flawed

Your attorney may also challenge the evidentiary weight of the IME’s opinion. If the IME’s understanding of your medical condition is incomplete, a claim can be filed to render their opinion incompetent. This can be done by investigating the IME’s qualifications and experience. If the IME lacks expertise in your specific condition or has not kept up with current medical practices, these factors can weaken their credibility.

Gathering Evidence to Support Your Case

Supporting medical evidence is another way to challenge an IME’s findings. This can include:

  • Collecting Your Medical Records and Treatment History: Present your medical records to counter the IME’s conclusions and provide documentation of your diagnosis and treatment.
  • Obtaining an Independent Evaluation: Seek a second opinion from your own medical providers to refute the IME’s findings.

Inconsistencies between the IME’s documentation and previous opinions from your treating physicians, or deviations from medical guidelines, can also be used to challenge the IME’s findings.

Scrutinizing the IME’s Methodology

The IME’s methodology can be another point of challenge. If the examination techniques did not adhere to appropriate protocols, necessary diagnostic tests were omitted, or standard evaluations for your injury type were neglected, these points can be raised. For disputes regarding the reasonableness or necessity of treatment, your attorney may request a utilization review. If the findings of the review organization are unfavorable, they can file a petition for review within 30 days of receiving the report.

Conflicts of interest can further undermine an IME’s credibility. Investigating the IME’s relationship with the employer or insurance company can reveal potential biases that cast doubt on their objectivity.

Additionally, depositions and supporting documentation can strengthen your challenge. Written statements or testimonies from coworkers, family, or friends about how your injury has affected your daily life and work capabilities may provide additional evidence.

Contact Stern & Cohen for Help

Challenging an IME’s opinion is crucial for protecting your rights and ensuring you receive the benefits you deserve. If you believe an IME’s opinion is not credible, the experienced attorneys at Stern & Cohen are here to help. We will guide you through the process, build a strong case on your behalf, and fight to secure the compensation you are entitled to. Contact us today for a consultation.