Common Pain Points in Independent Medical Exams

Independent Medical Exams (IMEs) are supposed to bring clarity to complex claims. When done well, they provide defensible, evidence-based opinions that support timely resolution. But for many adjusters, attorneys, and case managers, the process of getting from referral to report can be challenging. Scheduling delays, vague reports, and process gaps often overshadow the value IMEs are meant to provide. For claims professionals already managing heavy caseloads, even small IME process failures become major pain points.

Scheduling Delays and Logistics

Coordinating independent medical exams is rarely straightforward. Between limited physician availability, claimant scheduling conflicts, and travel logistics, even routine exams can take weeks to arrange. Missed or canceled appointments only add to the delays.

Those lost days are costly. Research from the Workers’ Compensation Research Institute (WCRI) shows that claims with delayed medical milestones are not only more likely to result in prolonged disability but can drive claim costs up by thousands of dollars. For high-exposure cases, waiting even an extra month for an IME often means additional weeks of indemnity payments, extended treatment, and slower resolution.

Leading IME vendors help mitigate this risk by investing in scheduling technology, claimant reminders, and expansive physician networks. Something as simple as automated text or email reminders, which are proven to reduce no-show rates across healthcare, can be just as effective in keeping IME appointments on track.

Lack of Transparency Before Independent Medical Exams

Too often, adjusters send off a carefully prepared IME packet and then go weeks without any updates, leaving unanswered questions. Was the full set of records received? Did the physician confirm the appointment? Were all the referral questions included? The silence creates unnecessary uncertainty, and when issues later surface, the fallout is costly.

Something as simple as a missing MRI or incomplete job description can undermine the credibility of the report or even require a re-exam, adding both expense and delay. According to the California Division of Workers’ Compensation, duplicate or repeat independent medical exams are one of the most common drivers of avoidable claim costs.

The solution is proactive communication. Top IME vendors offer real-time status dashboards and automated updates so adjusters can track every step: record receipt, physician acceptance, and claimant confirmation. Some also provide secure online portals where adjusters can upload additional records as they become available, ensuring physicians walk into the exam with the complete picture.

Limited Physician Networks

IME scheduling is only as strong as the network behind it. In many regions, adjusters face weeks-long waits simply because qualified physicians aren’t available. The gaps are especially pronounced in high-demand specialties like orthopedics, neurology, and psychiatry, areas that often drive the most complex and costly claims.

The National Council on Compensation Insurance (NCCI) consistently identifies musculoskeletal conditions as among the highest-cost drivers in Workers’ Compensation. In fact, NCCI’s 2023 report found that medical costs for musculoskeletal claims are nearly double the average across all claim types. For an adjuster trying to resolve a disputed back surgery or shoulder injury, access to an impartial orthopedic specialist is essential for both cost containment and claim defensibility.

When IME networks are too thin, adjusters are forced into tough trade-offs: accept long delays or risk using evaluators who may be overused by payers, creating the appearance of bias. Either scenario opens the door to disputes and added expenses.

Best-in-class IME partners maintain broad, credentialed networks with both geographic reach and specialty depth. They also actively vet physicians for impartiality, reducing the chance a report will be challenged on the grounds of bias.

Administrative Burden on Adjusters

Independent medical exams require far more than sending a referral. Adjusters often spend hours collecting scattered medical records, drafting detailed cover letters, and coordinating logistics between providers, claimants, and legal teams. For professionals managing dozens, or even hundreds, of active claims, this clerical work drains time and attention that should be spent on higher-value activities like strategy, reserving, and claim resolution.

The Coalition Against Insurance Fraud’s 2024 Insurance Workforce Study found that “administrative overload” ranks as one of adjusters’ top frustrations, second only to caseload volume. Independent medical exams are a prime example of where that burden becomes visible: when record packets are incomplete, cover letters vague, or documentation misfiled, the result is often a weaker IME report that can’t stand up under scrutiny.

To address this, leading IME vendors provide end-to-end administrative support, including record collection, packet preparation, and even assistance with tailoring questions for the examiner. Offloading these tasks not only improves report quality but also allows adjusters to stay focused on outcomes, resolving claims faster, reducing disputes, and ensuring defensibility.

Lack of Support After Independent Medical Exams

Too often, IME reports land in an adjuster’s inbox as a static PDF with no context or follow-up support. Adjusters are left to interpret vague findings, determine whether recommendations are defensible, and decide if clarification is needed, all while balancing heavy caseloads. Without additional guidance, the value of the IME is diminished, and in many cases, disputes or even costly re-exams become inevitable.

Example:

If an IME physician simply concludes, “surgery is not recommended at this time,” the statement may not hold up under legal scrutiny unless it’s explicitly tied to evidence-based guidelines such as those published by the Official Disability Guidelines (ODG) or the American College of Occupational and Environmental Medicine (ACOEM). Lack of clear linkage between findings and treatment recommendations is a frequent source of litigation, with opposing counsel often exploiting vague language to challenge claim decisions.

Strong IME partners close this gap by offering post-report support. This can include physician consultations with adjusters, peer review options for complex cases, and clarification requests built into the process. These services help transform the IME from a one-off report into a defensible, actionable tool that strengthens claims resolution and reduces disputes.

Want to streamline your IME process? Talk to us today.

Check out our sources:

“Inflation and Workers Compensation Medical Costs — Prescription Drugs.” NCCI Insights, 28 Mar. 2023, https://www.ncci.com/Articles/Pages/Insights-Inflation-WorkersComp-Medical-Costs-Prescription-Drugs.aspx.

Pieretti, Luis F., Karl V. Siegfried, and Robert A. Sylvester. “Medical Cost of Workers’ Compensation Claims Related to Patient Handling and Mobility Tasks Within Skilled Nursing Facilities, Continuing Care Retirement Communities and Assisted Living Facilities: An Exploratory Analysis.” Journal of Occupational and Environmental Medicine, vol. 62, no. 12, Dec. 2020, pp. e738–e747. https://stacks.cdc.gov/view/cdc/225769.

Wang, Dongchun, Kathryn L. Mueller, and Randall D. Lea. Patterns and Trends of High-Cost Claims Involving Rotator Cuff Disorders. Workers’ Compensation Research Institute, July 2025.