Independent Medical Examinations and Legal Depositions

  • Fady Y. Hijji
  • Ankur S. Narain
  • Krishna T. Kudaravalli
  • Kelly H. Yom
  • Edward Goldberg
  • Kern SinghEmail author


Work-related injuries are a frequent cause of workplace absence and chronic disability. Worker’s compensation has been developed to protect injured workers and to serve as a method for cost control. In order to adequately assess a patient’s injury, prognosis, and functional status, as well as the injury’s association with the workplace environment, an independent medical examination (IME) is necessary. Several guidelines have been established to assist physicians in performing IMEs in order to ensure thorough medical evaluations. Additionally, the limited relationship that exists between a physician and a patient during an IME is thought to facilitate the objective medical evaluation of a patient. However, this limited relationship has served as a source of controversy due to potential conflicts of interest and questionable physician liability. By appropriately informing and consenting the patient, adhering to established medical guidelines, and utilizing up-to-date evidence-based medicine, a physician can perform an objective and adequate IME.


Worker’s compensation Independent medical examination Work injury Patient-physician relationship The American College of Occupational and Environmental Medicine Functional status Chronic pain Conflicts of interest Physician liability Employer 



No funds were received in support of this work. No benefits in any form have been or will be received from any commercial party related directly or indirectly to the subject of this manuscript.


  1. 1.
    Badley EM, Rasooly I, Webster GK. Relative importance of musculoskeletal disorders as a cause of chronic health problems, disability, and health care utilization: findings from the 1990 Ontario health survey. J Rheumatol. 1994;21(3):505–14.PubMedGoogle Scholar
  2. 2.
    Clifton DW Jr. The functional IME: a linkage of expertise across the disability continuum. Work. 2006;26(3):281–5.PubMedGoogle Scholar
  3. 3.
    Brage S, Nygard JF, Tellnes G. The gender gap in musculoskeletal-related long-term sickness absence in Norway. Scand J Soc Med. 1998;26(1):34–43.PubMedCrossRefGoogle Scholar
  4. 4.
    Lax M. Independent of what? The independent medical examination business. New Solut. 2004;14(3):219–51.PubMedCrossRefGoogle Scholar
  5. 5.
    Ky P, Hameed H, Christo PJ. Independent medical examinations: facts and fallacies. Pain Physician. 2009;12(5):811–8.PubMedGoogle Scholar
  6. 6.
    Ameis A, Zasler ND. The independent medical examination. Phys Med Rehabil Clin N Am. 2002;13(2):259–86. ixPubMedCrossRefGoogle Scholar
  7. 7.
    Schofferman J. Opinions and testimony of expert witnesses and independent medical evaluators. Pain Med. 2007;8(4):376–82.PubMedCrossRefGoogle Scholar
  8. 8.
    Morton WE. In response to the 2002, vol. 22, no. 4 article entitled the rise and fall of occupational medicine in the United States. Am J Prev Med. 2002;23(4):309.PubMedCrossRefGoogle Scholar
  9. 9.
    Aldrich M. Safety first: technology, labor, and business in the building of work safety. Baltimore, Maryland: Johns Hopkins University Press; 1997.Google Scholar
  10. 10.
    Baum K. Independent medical examinations: an expanding source of physician liability. Ann Intern Med. 2005;142(12 Pt 1):974–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Heilbronner RL. Independent medical evaluation. In: Kreutzer JS, DeLuca J, Caplan B, editors. Encyclopedia of clinical neuropsychology. New York: Springer New York; 2011. p. 1305–6.CrossRefGoogle Scholar
  12. 12.
    Trescot AM, Boswell MV, Atluri SL, et al. Opioid guidelines in the management of chronic non-cancer pain. Pain Physician. 2006;9(1):1–39.PubMedGoogle Scholar
  13. 13.
    Manchikanti L, Abdi S, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. 2013;16(2 Suppl):S49–283.PubMedGoogle Scholar
  14. 14.
    Manchikanti L, Singh V, Derby R, et al. Review of occupational medicine practice guidelines for interventional pain management and potential implications. Pain Physician. 2008;11(3):271–89.PubMedGoogle Scholar
  15. 15.
    Williams MA, Mackin GA, Beresford HR, et al. American academy of neurology qualifications and guidelines for the physician expert witness. Neurology. 2006;66(1):13–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Patient S, Professional Liability Committee of the American College of S. Statement on the physician acting as an expert witness. Bull Am Coll Surg. 2011;96(4):39–40.Google Scholar
  17. 17.
    van der Giezen AM, Bouter LM, Nijhuis FJ. Prediction of return-to-work of low back pain patients sicklisted for 3-4 months. Pain. 2000;87(3):285–94.PubMedCrossRefGoogle Scholar
  18. 18.
    Bailey BE, Freedenfeld RN, Kiser RS, Gatchel RJ. Lifetime physical and sexual abuse in chronic pain patients: psychosocial correlates and treatment outcomes. Disabil Rehabil. 2003;25(7):331–42.PubMedCrossRefGoogle Scholar
  19. 19.
    Koppenhoefer RM. In: Delisa JA, editor. Disability evaluation in rehabilitation medicine: principles and practice. Philadelphia: Lippincott; 1988.Google Scholar
  20. 20.
    Suk M, Udale AM, Helfet DL. Orthopaedics and the law. J Am Acad Orthop Surg. 2005;13(6):397–406.PubMedCrossRefGoogle Scholar
  21. 21.
    Ebrahim S, Sava H, Kunz R, Busse JW. Ethics and legalities associated with independent medical evaluations. CMAJ. 2014;186(4):248–9.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Grant D. Independent medical examinations and the fuzzy politics of disclosure. CMAJ. 1997;156(1):73–5.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Camilleri M, Gamble GL, Kopecky SL, Wood MB, Hockema ML. Principles and process in the development of the Mayo Clinic's individual and institutional conflict of interest policy. Mayo Clin Proc. 2005;80(10):1340–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Ashar BH, Miller RG, Powe NR. Extent and determinants of physician participation in expert witness testimony. South Med J. 2005;98(4):444–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Fady Y. Hijji
    • 1
  • Ankur S. Narain
    • 1
  • Krishna T. Kudaravalli
    • 1
  • Kelly H. Yom
    • 1
  • Edward Goldberg
    • 1
  • Kern Singh
    • 1
    Email author
  1. 1.Department of Orthopedic SurgeryRush University Medical CenterChicagoUSA

Personalised recommendations