What Risks are Involved with Independent Medical Exams (IMEs)?
Risk Management

What Should You Consider with Independent Medical Exams (IMEs)?

Question: While performing an IME the other day, I wondered what would happen if the patient decided to put off needed treatment as a result of the screening. If the patient was later found to have a serious health condition, could I be held liable for failing to identify the problem or for failing to refer the patient?


Answer: It depends. Courts have differed on whether a doctor performing a physical examination for an insurance company owes a duty of care to the person being examined.

To minimize your risks, consider using these "do's" and "don'ts" in your practice management.

Do

Have your assistant in the exam room. IMEs are often performed on people involved in litigation or other adversarial situations. They typically are not pleased to be there in the first place, and a witness can provide further protection in the situation.

Stress the limitations of the examination in your communications with the patient. Knowing the limitations of the exam, the person should understand that an IME will not replace needed healthcare treatment. 

Send the patient a letter noting any serious conditions or warning signs you uncover. Advise the person to consult his or her physician immediately. Saying nothing about the person's potential health conditions will not play well before a jury if there is a suit. 

Check with your state to find out whether performing IMEs is allowed. NCMIC does provide coverage for IMEs, chiropractic utilization reviews and peer reviews—unless specifically prohibited by your state's scope of practice.

Have the patient sign a form acknowledging the exam:

  • Does not establish a doctor-patient relationship—the doctor is serving in the capacity of the insurance company's consultant. 
  • Is done at the request of and is paid for by the insurance company to determine whether additional healthcare services are necessary.
  • Is not intended as a substitute for a complete physical.

Don't

Provide treatment or offer advice if you are solely performing an IME. If you exceed the boundaries of the IME exam, you may create a doctor/patient relationship with all its attendant duties and potential liability.

Make disparaging remarks about the quality of care provided by the treating doctor. Suits alleging defamation or interference with a contractual relationship can be costly—even when successfully defended.

Recommend that treatment be discontinued, unless doing so would prevent possible injury. The doctor should instead provide clinical information based on the examination and let the company draw its own conclusions.

Adapted with permission from PracticeMakers. 


The information in the NCMIC Learning Center is offered solely for general information and educational purposes. It is not offered as, nor does it represent, legal or professional advice. Neither does this information constitute a guideline, practice parameter or standard of care. You should not act or rely upon this information without seeking the advice of an attorney familiar with the specific legal requirements of the state(s) in which you practice. If there is a discrepancy between the site and an insurance policy you have with NCMIC, the policy will prevail.