Insurers will often request an Independent Medical Exam (IME) to obtain a second opinion on a workplace injury. This is because the insurance company wants to verify the recovery timeline, whether the claim involves a nurse getting injured while lifting a patient or a delivery driver getting into an auto accident.
Because this appointment directly affects ongoing medical care, knowing what the insurance company can demand protects an injured worker’s right to fair compensation.
What the insurer has the right to require
The insurer uses the IME to answer specific medical questions. The evaluation determines if a worker has reached maximum medical improvement or if proposed treatments are necessary.
State law gives the insurer power over specific parts of the process such as:
- Mandatory attendance: The worker must attend the appointment. Missing the exam gives the insurer grounds to suspend wage benefits or close the claim.
- Doctor selection: The insurer selects the evaluating doctor to perform the exam and pays the invoice.
- Scope of review: The exam focuses strictly on the injury and treatment plan rather than providing ongoing care.
While the insurer controls scheduling, state rules limit their power during the exam.
What the insurer cannot dictate
The insurance company cannot control every detail. The IME doctor provides an evaluation; they do not replace the treating physician.
Colorado rules protect workers from overreach in the following areas:
- Travel costs: The insurer must cover travel expenses. If the appointment requires missing work, the insurer owes lost wage benefits for the missed hours.
- Exam room privacy: The evaluating doctor might exclude family members from the room, but the insurer cannot ban medical observers. State law allows injured workers to bring and pay for their own observing physician.
- Treatment changes: The insurer cannot force a treatment change without following proper legal steps to dispute the care plan of the treating physician.
These rules maintain fairness as the claim moves toward a final decision.
Where this leaves injured professionals
Workers’ compensation claims rely on medical evidence. The report from the IME physician carries significant weight with the state division. An unfavorable report can halt wage benefits or stop necessary treatments.
Preparing for this exam means you must know which medical records the doctor will review. An attorney who understands Colorado workers’ compensation claims can help injured employees manage the process. A skilled attorney can review the final report and dispute mistakes before they harm the case.