Why Is the Insurance Company Sending Me for an IME? What Massachusetts Workers Need to Know.

doctor-and-patient-photo-1024x683 If you’re hurt on the job and receiving workers’ compensation benefits in Massachusetts, there’s a good chance the insurance company will eventually send you a letter telling you to attend something called an IME.

Most injured workers panic when this happens — and for good reason. An IME can affect your weekly checks, your medical treatment, and the entire direction of your case. But once you understand what an IME really is, why the insurance company is sending you to one, and how the results are used, you’ll be in a much better position to protect yourself.

This guide breaks it all down in simple, blue-collar language.

What Exactly Is an IME?

IME stands for Independent Medical Examination.

But the name is misleading. The doctor isn’t independent, and this exam is not for your benefit. The exam is ordered by the insurance company, done by a doctor they choose, and performed for the sole purpose of giving the insurer a medical opinion that can be used to:

Stop or reduce your weekly checks
Deny or limit your medical treatment
Claim you can go back to work
Say your condition is “pre-existing”
Dispute whether your injury is work-related

The doctor is not your treating physician and has no intention of giving you medical advice or helping you heal. Their job is simply to examine you quickly, review your medical records, and submit a written report that the insurer can use.

Why Is the Insurance Company Sending You for an IME?

Insurance companies do not send workers to IMEs “just because.” An IME is almost always ordered for one of these reasons:

1. They want to stop your weekly checks.

If you’ve been out of work for a while, the insurance company will eventually look for ways to terminate or reduce benefits. An IME gives them ammunition to argue you’re no longer disabled.

2. They want to deny medical treatment.

If your doctor recommends surgery, injections, or even more physical therapy, the insurer may send you to an IME to get a doctor to say the treatment isn’t “reasonable and necessary.”

3. They want to challenge the cause of your injury.

For injuries involving repetitive movements, pre-existing arthritis, or cumulative trauma, insurers love to use IMEs to claim your problem isn’t work-related.

4. They want to claim you can go back to work.

Even if your job is heavy and physical, IME doctors often claim you can perform “light duty,” even if your employer doesn’t actually have a light-duty job available.

5. They’re responding to a claim your lawyer filed.

Anytime your attorney files a claim at the Department of Industrial Accidents (DIA), the insurer usually responds by scheduling an IME.

6. It’s part of their routine claims process.

Some insurers order an IME every 90 days or every 6 months, just to check whether they can challenge the claim.

Do You Have to Attend the IME?

Yes. In almost every Massachusetts workers’ comp case, you are required to attend the IME. If you don’t show up, the insurance company can legally:

Stop your weekly checks
Refuse to pay medical bills
Claim you’re “uncooperative”

That’s why it’s important to attend — but also important to be prepared.

If the date doesn’t work, your attorney can request a new appointment. Never skip an IME without talking to your lawyer first.

What Happens During an IME?

Surprisingly little. Most IME exams last 5–15 minutes, even for major injuries. Here’s what usually happens:

You arrive at the doctor’s office and check in.
The doctor looks through your medical records.
The doctor asks a few questions:
- How did you get hurt?
- What symptoms do you still have?
- What is your pain level?
- What work duties did you perform before the injury?
- Can you sit, stand, walk, or lift?
The doctor performs a quick physical exam.
The doctor writes a report for the insurance company.

You will not receive treatment, prescriptions, or referrals. This is not a real medical appointment — it’s a legal step in your workers’ compensation case.

Can You Bring Someone With You?

Yes. You can bring a family member or friend to the office, but most IME doctors do not allow anyone else inside the examination room. They may say it violates office policy or interferes with the exam.

You also cannot record the appointment unless the doctor gives permission. Most refuse.

How to Protect Yourself at an IME

✔ Be honest, not dramatic.

Never exaggerate — it can be used against you. But don’t minimize your pain either.

✔ Describe your real work duties.

Insurance companies often claim injured workers can return to “light duty,” but most real-world jobs involve:

Lifting heavy materials
Climbing ladders
Working overhead
Repetitive movements
Standing on concrete all day

Be clear about what your job actually required.

✔ Explain what activities make your symptoms worse.

Examples:

Standing too long
Bending
Walking upstairs
Lifting anything heavy
Gripping tools
Driving

✔ Don’t feel rushed.

IME doctors often move quickly. It’s okay to slow things down and explain your limitations fully.

✘ Don’t say you’re “fine” or “OK.”

Many people say this automatically but then struggle to move around. IME doctors notice this — and write it in their report.

✘ Don’t try to tough it out.

If something hurts, say so. Pride can cost you benefits.

✘ Don’t talk about your workers’ comp claim.

The doctor is not your ally. Do not discuss:

Settlement
Past benefits
Whether you think the insurer is treating you fairly

Stick to medical facts.

What Happens After the IME?

After the exam, the doctor sends a report to the insurance company. The report typically addresses:

Whether your injury is work-related
Whether treatment is necessary
Whether you are disabled
Whether you can return to light duty
Whether you reached a “medical end result”

Here’s what usually happens next:

1. The insurer may try to stop your weekly checks.

If the IME doctor says you can work, the insurer may file a complaint to modify or terminate benefits.

2. The insurer may deny medical treatment.

If your doctor wants surgery or injections, the IME is often used as the reason for denial.

3. Nothing happens immediately.

Sometimes the insurer just keeps the report on file until a dispute comes up.

Does the Judge Have to Believe the IME Doctor?

No. The IME doctor’s opinion is not final.
In Massachusetts, judges look at all medical evidence, including:

Your treating doctors
Specialists
MRI or X-ray results
Your physical therapist’s notes
Your testimony about your limitations

Insurance IMEs often have little weight compared to treating physician opinions — especially from orthopedic surgeons, neurosurgeons, or pain specialists who have been following you regularly.

What Should You Do If the IME Report Is Bad?

A bad IME report doesn’t mean your case is lost. Your attorney can:

File a claim
Challenge the report at a Conciliation
Bring your treating doctor’s opinions
Submit diagnostic tests
Get you evaluated by another specialist
Present your testimony at a Conference

Some of the strongest cases come after a very unfavorable IME, because it clearly shows the insurer is acting in bad faith.

How a Lawyer Makes a Huge Difference with IMEs

A workers’ comp attorney can:

Prepare you before the IME
Request a reschedule if needed
Explain what to say (and not say)
Challenge the IME’s accuracy
File claims if the insurer uses the report unfairly
Bring better medical evidence to a judge
Protect your weekly checks
Fight for your surgery or treatment

The insurance company is already using a doctor they hired. You should not be facing that alone.

Final Thoughts

IME notices can be intimidating, but they’re a normal part of almost every Massachusetts workers’ comp claim. What matters is how you prepare, how you handle the appointment, and what steps you and your lawyer take afterward.

An IME is simply one opinion — and it can be challenged.