The short answer: An independent medical exam (IME) is usually a one-time evaluation requested by the workers’ comp insurer, where a doctor you don’t normally see examines your injury and writes a report. It isn’t treatment, and that report can affect your benefits and your impairment rating. You should take it seriously, but South Carolina law gives you real rights, including the right to bring your own doctor.
Receiving a letter that orders you to see a doctor you’ve never met can feel unsettling, especially when you’re already hurt, out of work, and worried about your next paycheck. If the insurance company on your South Carolina workers’ comp claim has scheduled an independent medical exam, you’re probably wondering what it means and whether it’s a trap. A consultation with our Mauldin workers’ compensation attorneys is always free.
In this article, we will cover the following:
- What is an IME in a workers’ comp case?
- Who requests an IME, and why should that concern you?
- How is an IME different from your authorized treating physician?
- What happens during a workers’ comp IME?
- Can a bad IME report reduce your benefits or impairment rating?
- How can you protect your claim before and after an IME?
- How Smith & Jones Law can help
- Frequently asked questions about workers’ comp independent medical exams
What is an IME in a workers’ comp case?
An IME is a medical examination you must attend so a physician can assess your work injury and report the findings. South Carolina uses a no-fault workers’ compensation system, so you do not have to prove your employer was negligent to receive benefits, but you do have to prove your injury and how it limits you. Under South Carolina law, once you are injured and claiming compensation, the employee, if requested by the employer or ordered by the commission, shall submit to examination, at reasonable times and places, by a qualified physician or surgeon designated and paid by the employer or the commission (S.C. Code Ann. § 42-15-80).
The word “independent” is misleading because the doctor is usually chosen and paid by the insurance company, not by you. This isn’t a visit to treat you. It’s an evaluation, and the report becomes evidence in your claim.
Who requests an IME, and why should that concern you?
In most cases, the employer’s insurance carrier requests the IME. They usually do this when they want a second look at your diagnosis, your treatment, your work restrictions, or whether they believe you’ve recovered as much as you are going to.
That’s worth your attention because the insurer pays for the exam and has a financial interest in the result. A report that downplays your injury can be used to cut off your benefits or reduce what you’re owed. That doesn’t make the exam automatically unfair, but it does mean you should be prepared.
How is an IME different from your authorized treating physician?
Your authorized treating physician is the doctor who actually manages your care over time. In South Carolina, the employer’s representative chooses an authorized health care provider and pays for your treatment. By contrast, the IME doctor usually examines you once and doesn’t treat you at all.
If you disagree with the IME findings, you may be eligible for a workers’ comp second opinion. Under S.C. Code Ann. § 42-15-80, you have the right to have present at the examination any qualified physician or surgeon provided and paid by you. Separately, under S.C. Code Ann. § 42-17-30, the commission or any member thereof may, upon the application of either party or upon its own motion, appoint a disinterested and duly qualified physician or surgeon to make any necessary medical examination of any employee and to testify in respect thereto.
What happens during a workers’ comp IME?
Expect the doctor to review your records, ask how the injury happened, ask about your symptoms, and perform a physical exam. Be honest and consistent; don’t exaggerate or downplay your pain.
Keep in mind that nothing you say is truly private here. Under South Carolina law, a fact communicated to or otherwise learned by any physician or surgeon who may have attended or examined the employee, or who may have been present at any examination, is not privileged in your case. Stick to the facts about your injury and how it affects your daily life and work.
Can a bad IME report reduce your benefits or impairment rating?
Yes. An unfavorable IME report can hurt your claim in several ways. The insurer may use it to argue you’ve reached maximum medical improvement, to lower your permanent impairment rating, or to stop your weekly checks.
Those ratings matter because they help decide how long your benefits last. For most on-the-job injuries in South Carolina, the compensation period may not exceed 500 weeks, except as provided in subsection (C) (S.C. Code Ann. § 42-9-10). There’s an important exception: any person determined to be totally and permanently disabled who, as a result of a compensable injury, is a paraplegic, a quadriplegic, or has suffered physical brain damage is not subject to the 500-week limitation and shall receive the benefits for life. A lower rating can mean fewer weeks of benefits, so the stakes are real.
Facing an IME on your South Carolina workers’ comp claim? Call Smith & Jones Law at 803-784-0730 for a free consultation.
How can you protect your claim before and after an IME?
Preparation is your best protection. Keep going to your authorized appointments, follow your doctor’s orders, and don’t skip the IME, because if the employee refuses to submit himself to or in any way obstructs the examination requested by and provided for by the employer, his right to compensation and his right to take or prosecute a proceeding under this title must be suspended until the refusal or objection ceases.
Bring a list of your symptoms, describe your limitations accurately, and jot down what happened at the exam afterward while it’s still fresh. If the report is unfair, you have options, including a second opinion and a hearing before the Commission. This is where having our attorneys review the report can make a difference.
How Smith & Jones Law can help
Workers’ compensation is one of our primary practice areas, along with auto accidents, and our attorneys bring 55 years of combined experience to South Carolina injury claims. We know how insurers use IME reports, and how to respond with strong medical evidence and your own doctor’s opinion.
You don’t have to sort this out alone. From our offices in Lexington and Mauldin, we help injured workers across South Carolina protect their benefits. Contact Smith & Jones Law today for a free consultation.
Frequently asked questions about workers’ comp independent medical exams
Do I have to go to the IME?
Generally, yes. South Carolina law requires the employee to submit to examination at reasonable times and places while claiming compensation, and refusing or obstructing the exam suspends the right to compensation until the refusal ceases. If the time or place is genuinely unreasonable, talk to an attorney before you miss the appointment.
Can I receive my own second opinion?
Often, yes. Under S.C. Code Ann. § 42-15-80, you have the right to have present at the examination any qualified physician or surgeon provided and paid by you. Under S.C. Code Ann. § 42-17-30, the commission may also appoint a disinterested and duly qualified physician to make any necessary medical examination of an employee and to testify. A second opinion carries the most weight when it’s backed by solid medical evidence.
How much does it cost to hire a workers’ comp lawyer?
Your consultation with Smith & Jones Law is free. We’ll review your IME notice and your claim, explain your options, and answer your questions with no obligation. Contact us at 803-784-0730 to get started.