Independent Medical Examinations (IME) in Virginia Workers' Comp: How to Protect Your Claim

What is an Independent Medical Examination in Virginia?

If you have been receiving workers' compensation benefits in Virginia for a while, the insurance company will inevitably demand that you attend an Independent Medical Examination (IME). Under Va. Code Ann. § 65.2-607, the employer or their insurance carrier has the legal right to have you examined by a physician of their choosing. The purpose of this exam is rarely to help you heal. Instead, the insurance adjuster is looking for medical evidence to lower their costs. They want the IME doctor to state that you have fully recovered, that you require no further surgeries, or that you can return to full-duty work immediately. Understanding that this doctor is working for the insurance carrier, not for you, is the key to protecting your claim at the Virginia Workers' Compensation Commission, Richmond.

Answering Tricky Questions from the IME Doctor

Attending an IME is more like a legal deposition than a normal doctor's visit. The physician will observe everything you do, from how you exit your car in the parking lot to how you sit in the waiting room chair. During the exam, they will ask questions designed to minimize your injury.

• Do not exaggerate, and do not minimize. If the doctor asks about your pain level, be perfectly honest. Do not say your pain is a '10 out of 10' if you drove yourself to the appointment, as this damages your credibility. Conversely, do not try to act tough and say 'it's not that bad' when you are in agony.
• Stick to the facts of the workplace accident. The doctor may ask about old sports injuries or minor car accidents from your past, attempting to blame your current back pain on a pre-existing condition. State the facts clearly: 'I was completely fine and working full-time until I fell from the scaffolding on the job.'
• Be prepared for brief exams. Many workers are shocked when an IME lasts only 10 minutes. The doctor is not there to treat you; they are only there to write a report for the insurance company.

What to Do if the IME Doctor Releases You to Full Duty Prematurely

The most common outcome of an IME is a report sent to the insurance company stating that you have reached Maximum Medical Improvement (MMI) and can return to full-duty work without restrictions. The insurance adjuster will immediately use this report to file an application to terminate your weekly wage checks. Do not panic. Under Virginia law, the opinion of the IME doctor does not automatically override the opinion of your authorized treating physician. You will need your actual treating doctor to write a strong, detailed medical rebuttal explaining exactly why you are still injured and cannot work. If the medical evidence is conflicting, a Deputy Commissioner at the Virginia Workers' Compensation Commission, Bristol or another regional office will hold a hearing to decide whose medical opinion is more credible.

Legal Limits on How Many IMEs Can Be Demanded

Insurance companies sometimes try to harass injured workers by scheduling multiple IMEs, hoping to find a doctor who will finally say what they want to hear. Virginia law does not allow unlimited exams. The Commission requires that requests for an IME be 'reasonable.' If an insurance carrier schedules an IME, they generally cannot demand another one for a significant period (often a year) unless your medical condition drastically changes or you require an evaluation from a completely different type of specialist (e.g., seeing a neurologist after seeing an orthopedist). In the case of R.G. Moore Bldg. Corp. v. Mullins, 10 Va. App. 211 (VA Court of Appeals 1990), the courts established that while an employee must submit to a reasonable examination, an unjustified refusal by the employee is grounds for suspending benefits, making it crucial to challenge unreasonable IMEs legally rather than just skipping them.

How Much Does an IME Cost You?

You do not pay for the Independent Medical Examination. The workers' compensation insurance company is required to pay the physician's fees. Furthermore, under Virginia law, the insurance company must reimburse you for your mileage to and from the IME appointment. If you must hire a local attorney from our directory to defend your benefits at a hearing after a negative IME report, they will represent you on a contingency fee basis. This means they only take a commission approved by the state if they successfully preserve your benefits or negotiate a lump-sum settlement.

How Long Does the Dispute Process Take?

If the insurance company files to cut off your benefits based on an IME report, the Commission will typically schedule an evidentiary hearing within 3 to 5 months. It is vital to continue seeing your authorized treating doctor during this waiting period to build a solid medical record that contradicts the IME physician's brief evaluation.

Frequently Asked Questions (FAQ)