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What Is an Independent Medical Examination?

An independent medical examination may be required to claim worker's compensation or other benefits.
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  • Written By: Lainie Petersen
  • Edited By: Melissa Wiley
  • Last Modified Date: 20 August 2014
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An independent medical examination is an examination performed by a physician who is not connected to or involved with the patient being examined. The purpose of an independent medical examination is to determine the condition of a person who is claiming to be injured or ill in order to claim insurance benefits, workers' compensation, or damages in a lawsuit. Depending on the jurisdiction in which the examination takes place, an independent medical examination may be performed by a physician who has earned professional certification and who may even be licensed or registered with a governmental agency for the purpose of performing this type of examination.

When a person becomes ill or sustains an injury, he or she may make an insurance claim, need to take time off from work, or request a change in his or her work-related duties. In some cases, an individual may also believe that others are responsible for his or her condition and may file a lawsuit against the person or business in order to receive compensation for the losses and discomfort that result from his or her health condition. In such cases, reports from physicians and other health care professionals will typically be used to support the claims of the injured or ill individual.

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In many cases, people will initially see their own personal physician for diagnosis and care and may also use the services of specialists for advanced diagnostic services and treatment. From the perspective of insurers, employers, or defendants in a lawsuit, however, the opinions of these people may be compromised by their relationship with the patient. A personal physician, for example, may have a long history with the patient and be inclined to support the patient's contention that he or she is unable to work or requires insurance coverage for particular medical service. In addition, the physicians treating the individual may be receiving financial compensation either directly from the patient or from the patient's health insurance provider. This can provide physicians with a financial motive for supporting the patient's claims.

To the defense of their own interests, insurers, employers, or lawsuit defendants may insist on an independent medical examination performed by a physician who is not connected to the injured or ill individual. During this examination, the examining physician will evaluate the patient's history and physical condition and will make his or her own report as to whether the patient is as ill or injured as he or she claims or whether the current course of treatment prescribed by the patient's own physicians is appropriate. In some jurisdictions, a person may be ordered by a judge to undergo an independent medical examination or may be required to do so under the terms of his or her insurance policy. A failure to complete this requirement may result in a denial of benefits or compensation.

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