What Happens After a Workers’ Comp IME in Virginia?

After a workers’ comp IME in Virginia, the doctor the insurance company chose writes a report, and the insurance company uses it to decide what to do next: keep paying, try to stop or reduce your wage checks, deny treatment your own doctor recommended, or argue for a lower impairment rating. The IME doctor does not become your doctor and does not treat you. The report also does not decide anything on its own. If you disagree with it, the Commission decides.

Here is what the report usually covers, what the insurance company can and can’t do with it, and what happens when your doctor disagrees.

What Is an IME in Virginia Workers’ Comp?

An independent medical examination, or IME, is an exam by a doctor the insurance company picks and pays. Virginia law requires you to attend one when your employer asks, at a reasonable time and place. If you refuse to go or get in the way of the exam, your benefits can be suspended until you cooperate, and you may not be paid for that time unless the Commission finds you had a good reason (Va. Code § 65.2-607). You may bring a qualified doctor of your own to the exam, at your own expense.

The word “independent” is the insurance company’s. Here’s how to prepare for an IME in Virginia.

What the IME Report Usually Says

The IME doctor answers the insurance company’s questions. The report usually gives opinions on:

• Whether your condition was caused by the work accident, or is degenerative or pre-existing
• Whether you can work, and with what restrictions
• Whether treatment your doctor recommends, such as surgery, injections, or therapy, is reasonable and necessary
• Whether you have reached maximum medical improvement
• An impairment rating for any permanent loss of use

The report usually goes to the insurance company first. Commission rules require the insurance company to send you a copy promptly (16VAC30-50-50(B)).

What the Insurance Company Can Do With the Report

• Try to stop or reduce your wage checks. Once you have an award, the insurance company can’t just stop paying on its own. It has to file a sworn application with the Commission, backed by the medical reports it relies on, such as the IME report. It generally must pay you through the date it files. If the Commission rejects the application, your checks start again right away. If the Commission accepts it, your checks can stay stopped until the case is decided, and you have 15 days to respond (Va. Code § 65.2-708; 16VAC30-50-20(D) and (E)).
• Refuse to authorize treatment your doctor recommends. You can ask the Commission to order it.
• Argue for a lower impairment rating, which means fewer weeks of pay for permanent damage. Here’s how permanent partial disability is paid.
• Deny a claim it hasn’t accepted yet. A denial is not the final word. If you have received a denial of your workers’ comp claim, you have the right to dispute that decision and take your claim to a hearing before the Virginia Workers’ Compensation Commission.
• Use the report to argue for a lower number in settlement talks.

When Your Doctor and the IME Doctor Disagree

When the doctors disagree, the Commission weighs the medical evidence. In Virginia, the opinion of your treating physician is generally given great weight, because that doctor has seen you over time (Vital Link, Inc. v. Hope, 69 Va. App. 43, 64 (2018)). That is not automatic. The Commission can accept the IME doctor’s opinion if it finds it more persuasive, and a short or unexplained note from your own doctor can lose to a detailed IME report.

That is why what your treating doctor writes after an IME often matters more than the IME itself. A response that deals with the IME doctor’s reasons point by point carries more weight than a one-line disagreement, and doctors rarely write one unless someone asks the right questions.

What to Do After the IME

• Write down, the same day, how long the exam lasted, what the doctor examined and asked, and anything said that you disagree with.
• Ask for a copy of the report.
• Keep going to your own doctor and follow your treatment plan and work restrictions.
• Show the IME report to your treating doctor.
• Watch your mail for a letter from the insurance company or a notice that it filed an application with the Commission. Deadlines run from those.

If the insurance company denies treatment or stops checks, here’s what to do when the insurer delays your benefits and how to prepare for a Virginia workers’ comp hearing.