And sometimes, that doctor comes back with a report that says the one thing you’ve been dreading:
“The injury is not work-related.”
If that just happened to you, you’re not alone—and your case is far from over. At Carney, Rezendes & Crowley, we hear from injured workers every week who find themselves in this exact situation. This blog breaks down what that IME really means, what the insurance company is trying to do, and most importantly, what you can do next to protect your benefits.
What Is an IME and Why Does the Insurance Company Send You to One?
An IME is supposed to be an “independent” evaluation of your injury. In reality, the exam is:
- Requested and paid for by the insurance company
- Performed by a doctor they select
- Used to justify cutting or denying benefits
Insurance adjusters typically schedule an IME when:
- You have been out of work for a while
- Your medical bills are adding up
- Your doctor says you need a surgery or additional treatment
- They’re looking for an excuse to stop weekly checks
These IME reports often use buzzwords like “pre-existing condition,” “not causally related,” or “injury has resolved,” even when your treating doctor strongly disagrees.
Here’s the important part:
An IME doctor’s opinion does NOT control your case. It is simply one piece of evidence—and often a weak one.
Why IME Doctors Often Say Injuries Aren’t Work-Related
The insurance company’s goal is simple: pay less money.
Denying that your injury happened at work, or claiming it’s just due to age or a prior condition, is one of the fastest ways to do that.
IME doctors may conclude your injury isn’t work-related because:
- They rely on limited information
IME doctors usually spend 5–10 minutes with you and don’t personally know your job, duties, or the incident.
- They exaggerate “pre-existing conditions”
Even minor arthritis or an old injury can be used as an excuse to deny the claim.
- They are paid by insurance companies
Many IME doctors perform dozens or hundreds of insurance exams each year. They know who signs the check.
- They overlook job-related wear and tear
Massachusetts law recognizes cumulative trauma—years of heavy work, repetitive movements, or overuse. Many IME doctors ignore that reality.
- They frame injuries as “temporary”
Even severe injuries are often described as having “resolved,” even when you’re still in pain or unable to work.
When you get an IME report like this, it’s normal to panic. But legally, the case does not end here.
What Happens After an IME Says Your Injury Is Not Work-Related?
Here’s what you can expect next:
- The insurer may try to stop your weekly checks
Often, adjusters use the IME report to send a Form 107 or Form 108 notice cutting your benefits.
- They may deny paying for additional medical treatment
Surgeries, MRIs, injections, and physical therapy may suddenly be rejected.
- They may dispute the entire claim
If you haven’t started receiving benefits yet, the IME may be used to deny the claim outright.
- You may receive a Conciliation Notice from the DIA
This is the beginning of the legal process to challenge the denial.
When this happens, you DO NOT have to accept the IME opinion. You can challenge it—and injured workers challenge IMEs successfully every day.
How the Legal Process Works When an IME Is Negative
Once the insurer uses the IME to stop or deny benefits, your attorney files a claim (or a complaint to reinstate benefits). Here’s how CRC handles it:
Step 1: We obtain and review the full IME report
We immediately look for errors, contradictions, and exaggerations—IME reports are full of them.
Step 2: We gather strong medical evidence from your treating doctors
A well-written opinion from your own doctor can outweigh the IME completely.
Step 3: We present your case at Conciliation
Conciliation is an informal meeting at the Department of Industrial Accidents. Many insurers try to settle quickly here, especially if their IME is weak.
Step 4: We argue your case at a Conference
A judge reviews:
- Your medical records
- The IME
- Your treating doctor’s opinion
- Job descriptions
- Witness statements (if needed)
The judge can order the insurer to reinstate your checks even if the IME says your injury is not work-related.
Step 5: If necessary, we take the case to a full Hearing
This is a trial before a workers’ comp judge. Judges often reject IMEs when:
- The exam was rushed
- The doctor ignored major facts
- The report contradicts your medical records
- The IME doctor never reviewed your imaging or history
You don’t have to navigate any of this alone. This process is exactly what we handle for our clients every day.
When an IME Isn’t the Final Word: Examples of Common Wins
✔ Shoulder and knee injuries
IME says “degenerative arthritis” — treating surgeon explains it was aggravated by heavy work → benefits reinstated.
✔ Back injuries
IME says “resolved” — MRI shows herniation → judge orders continued benefits.
✔ Construction or trade workers
IME says “not related to work” — job duties show years of heavy lifting → judge rejects IME.
✔ Repetitive-use injuries
IME claims it’s “age-related” — treating doctor explains cumulative trauma → benefits approved.
IME opinions get overturned all the time. Insurance companies count on injured workers giving up—the ones who fight back usually win.
What You Should Do Immediately After a Negative IME
If you just received an IME that says your injury isn’t work-related, here’s what to do next:
- Don’t panic—this happens often
Insurance companies use IMEs strategically. A denial doesn’t mean you lose.
- Keep treating with your own doctor
Your treating physician’s opinion is usually more important than the IME’s.
- Don’t talk to the adjuster about the IME report
Anything you say may be used to support the denial.
- Gather job-related evidence
This includes:
- Photos
- Incident reports
- Statements from co-workers
- Job descriptions
- Equipment you were using
- Contact a workers’ compensation attorney immediately
Once an IME comes back negative, the insurance company is preparing to deny or stop benefits. You need someone preparing your case at the same time.
At CRC, we typically:
- File a claim or complaint to reinstate benefits
- Request supporting medical opinions from your doctor
- Challenge the IME’s conclusions
- Represent you at the DIA
- Work to get your weekly checks restarted as fast as possible
Why Having the Right Lawyer Makes All the Difference
Insurance companies rely on IMEs to intimidate workers into giving up. A good workers’ comp attorney knows:
- Which IME doctors routinely side with insurers
- How to expose flaws in the IME report
- How to gather medical evidence that outweighs the IME
- How to present your case to a judge in a compelling, credible way
Most importantly, an experienced lawyer levels the playing field.
CRC’s hands-on approach means you’re not getting passed around a giant firm or waiting weeks for a callback. You get direct communication, real explanations, and a team that knows the system inside and out.
Bottom Line: A Negative IME Does NOT Mean Your Case Is Over
IME reports are tools for insurance companies, not final decisions. Your injury, your job duties, and your medical history matter far more than a quick exam by a doctor who doesn’t know you.
If your IME report says your injury isn’t work-related:
You still have rights. You still have options. And you can still win your case.
CRC has helped thousands of injured workers—including union members, construction workers, warehouse workers, and public employees—overcome bad IMEs and get their benefits reinstated.
If you’re facing a denial or a reduction in benefits because of an IME, call us. We’ll review your IME report for free and explain exactly what steps we can take to protect you.