Independent Medical Examiners: The Secret Advantage in a Workers’ Comp Claim

www.claimsjournal.com, Kristina Jones, Sept. 9, 2025

A delivery driver reports hurting a shoulder while carrying a heavy package on the job. For months, the driver sends the insurer medical updates from a treating provider, but there is little sign of progress. Growing concerned, a claims manager at the insurance company arranges for an independent medical examination with a board-certified orthopedic specialist.

The exam confirms his suspicion: The claimant shows near-normal range of motion and appears to exaggerate the symptoms. Because the IME’s findings contrast sharply with the treating provider’s reports, the carrier can make a defensible decision, saving prolonged claims costs and setting the stage for a potential fraud investigation.

This scenario, while hypothetical, illustrates the inherent value of an IME in workers’ compensation defense. As claims move toward formal dispute or litigation, IMEs provide objective insights that help assess the validity of a claim and root out the growing problem of workers’ comp fraud.

It’s helpful to consider a few emerging IME trends and examine why claims managers should be proactive in requesting these essential evaluations. Continue article