What an Orthopedic IME Covers, Including Impairment Ratings

An orthopedic independent medical examination, or IME, answers questions that a treating doctor cannot answer neutrally. Is the injury what it is claimed to be? How severe is it? Has the treatment so far been reasonable? This post walks through what an IME looks at, what the written report contains, and where impairment ratings come in.

Who asks for an IME

IMEs are usually commissioned in insurance, legal, workers’ compensation or disability matters. The request most often comes from an employer or a workers’ compensation board, an insurer, a law firm on either side of a case, or a government or legal agency.

The examining physician has no treating relationship with the person being examined. That separation is what makes the opinion independent: the physician does not prescribe, treat, or take the person on as a patient.

What the examination reviews

A thorough orthopedic IME draws on four sources:

• Medical history: how the injury happened and what has followed.
• Imaging: X-ray, MRI or CT studies, read directly rather than only through earlier reports.
• Treatment record: prior notes, operative reports, medications and therapy.
• A focused physical examination: where the question calls for one.

Most examinations take 30 to 90 minutes in the room. The length depends on the injury, how much documentation there is, and how involved the physical examination needs to be. The records are then reviewed in detail afterwards.

What the report should contain

The output of an IME is a written report. It should set out the diagnosis, the functional limitations, treatment recommendations and the prognosis, in a form that will hold up under scrutiny. A useful report also:

• states causation plainly: whether the injury and the reported event are linked, and how much is pre-existing wear
• assesses functional limitation from what was examined, not from estimates
• notes any inconsistencies between what is reported and what is found
• gives a defensible basis for return-to-work and care decisions

Where impairment ratings fit

Some IMEs are asked for a permanent impairment rating: a measure of long-term impairment once the condition has stabilized. The rating is made against published clinical standards, so it rests on the examination findings and the record rather than on opinion alone. It is one of several questions an IME can answer, alongside causation, post-surgical recovery reviews and disputed opinions.

An IME is not advocacy

The findings are owed to no party: not the claimant, the employer, the insurer or counsel. They land wherever the evidence puts them.

What to bring

Photo identification, any recent imaging (X-ray, MRI or CT), medical records and operative notes, and an up-to-date list of medications and treatments.

ELITE Sports Medicine provides orthopedic IMEs, performed by a board-certified orthopedic surgeon, at its Port St. Lucie and Palm Beach Gardens offices. To arrange one, call 561-202-8886. Related services include compulsory medical examinations and medical legal reviews.