Do Case Managers Coordinate Independent Medical Exams (IMEs)?

Independent Medical Exams (IMEs) play a critical role in the claims process. They can help insurance adjusters like you, validate injuries, confirm treatment necessity, and resolve disputes. But where do case managers fit into this equation? Do they coordinate IMEs, or is that strictly an adjuster’s responsibility? Let’s break it down.

The Role of Case Managers in IMEs

Case managers serve as a bridge between injured workers, medical providers, employers, and insurance carriers. Their primary function is to facilitate medical care and ensure the patients’ treatment aligns with appropriate guidelines. When it comes to IMEs, their involvement can vary depending on jurisdiction, employer policies, and the complexity of the claim.

Do Case Managers Directly Schedule IMEs?

Typically, case managers do not have the authority to directly schedule an IME. That responsibility usually falls to the insurance adjuster, employer, or legal counsel, depending on the case. However, case managers often play a supportive and advisory role in the IME process by:

• Identifying cases where an IME may be necessary.
• Gathering and organizing medical documentation for the examiner.
• Communicating the need for an IME to the adjuster.
• Preparing the injured worker for what to expect.
• Discussing and reviewing findings with the adjuster.

When Might a Case Manager Recommend an IME?

Experienced adjusters know that not every claim requires an IME, but case managers—given their close monitoring of medical treatment—may suggest one in cases such as:

Conflicting Medical Opinions:

If the treating physician’s assessment doesn’t align with medical guidelines or other specialists’ opinions.

Delayed Recovery:

When the injured worker isn’t progressing as expected based on clinical timelines.

Treatment Concerns:

If recommended treatments appear excessive, experimental, or unnecessary.

Return-to-Work Disputes:

If a treating physician and employer disagree on work restrictions or fitness for duty.

Potential Fraud or Malingering:

If the worker’s reported symptoms don’t match objective medical findings.

Legal and Ethical Considerations for Case Managers

Case managers must navigate strict ethical guidelines when involved in the IME process. Since they function as medical liaisons rather than claims decision-makers, their goal is to facilitate a fair and transparent process by:

• Avoid influencing the IME provider’s opinion.
• Adhere to HIPAA and confidentiality regulations.
• Maintain impartiality and focus on medical facts.
• Ensure the injured worker understands the IME is independent and not a standard medical visit.

How Case Managers and Adjusters Can Work Together on IMEs

For an IME process to be effective, strong collaboration between adjusters and case managers is essential. Here are some things for both parties to keep in mind:

Proactive Communication: Regular case updates help identify IME needs early.

Data Sharing: Case managers should provide thorough medical records to the adjuster.

Clarifying Objectives: Adjusters should define specific questions for the IME physician based on case concerns.

Follow-Up: After an IME, both parties should review findings and strategize next steps.

To answer your question, while case managers don’t directly coordinate IMEs, they play a pivotal role in recognizing when an IME is needed, gathering the most crucial medical data, and ensuring smooth communication between all parties involved. Their insights help adjusters make informed decisions that help cost containment efforts.

As an experienced adjuster, leveraging the expertise of a case manager in the IME process can lead to faster claim resolutions, better medical outcomes, and reduced litigation risks. By understanding how to collaborate effectively, both of you can enhance the efficiency and fairness of the claims process.

Want to stay ahead in claims management? Read more of our related articles below or check out some of our Medical Management webinars.

Check out our sources!

National Association of Independent Review Organizations. Best Practices for Independent Medical Reviews and Peer Reviews. NAIRO, 2021.

National Conference of State Legislatures. Workers’ Compensation State Laws and IME Requirements. NCSL, 2023,

“Florida Statutes – Section 440.13.” The Florida Senate, 2024, http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/Sections/0440.13.html.