IME Services Explained

What you will find below:

• What Is an Independent Medical Exam (IME)?
• What Is a Peer Review?
• How Does a Medical Record Review Work?
• When Is an Addendum Review Needed?
• What Is Functional Capacity Evaluation (FCE) Coordination?
• Choosing the Appropriate IME Service

IME services help workers’ compensation and claims professionals address medical questions that arise during a claim.

IME services include independent medical exams, peer reviews, record reviews, addendum reviews, and functional capacity evaluation coordination.

What Is an Independent Medical Exam (IME)?

An Independent Medical Exam (IME) is an evaluation performed by a qualified medical professional to provide an independent opinion about an injured worker’s medical condition.

During an IME, the physician reviews relevant medical records, discusses the injured worker’s medical history, and performs an appropriate clinical examination. The physician then prepares a report addressing specific medical questions related to the claim.

An IME may help clarify the cause or extent of an injury, assess work restrictions, or determine whether an injured worker has reached maximum medical improvement (MMI). MMI refers to the point when a medical condition is not expected to improve significantly with further treatment.

An IME is appropriate when medical opinions conflict, existing records leave important questions unanswered, or an independent clinical assessment is needed.

What Is a Peer Review?

A peer review is an assessment in which a qualified medical professional evaluates medical documentation to address specific questions about treatment or other medical issues.

During a peer review, a physician or other appropriately qualified medical professional examines relevant medical records, treatment history, and clinical guidelines. Depending on the review type, the reviewer may assess whether proposed, ongoing, or completed treatment is medically necessary and appropriate.

For example, a peer review may evaluate whether a recommended surgery or course of physical therapy is supported by the injured worker’s documented medical condition.

Unlike an IME, a peer review does not involve a physical examination. Peer reviews are appropriate when claims professionals need an independent medical opinion about treatment recommendations or other questions supported by the available records.

How Does a Medical Record Review Work?

A medical record review allows a qualified medical professional to evaluate existing medical documentation and provide an independent opinion without examining the injured worker.

During a record review, the medical professional examines relevant documentation, such as physician notes, diagnostic reports, treatment histories, and prior evaluations. The reviewer identifies medical findings that address specific questions related to the claim.

For example, a record review may help clarify an injury timeline, evaluate conflicting medical findings, or assess whether documented medical evidence supports a reported condition.

While peer reviews often focus on treatment necessity or appropriateness, record reviews may address broader medical questions. The scope of the two services can overlap depending on the review request.

A record review is appropriate when the available medical documentation is sufficient to address the questions without an additional clinical examination.

When Is an Addendum Review Needed?

An addendum review allows a medical professional to address new information or follow-up questions after completing an initial medical report or review.

Additional medical records, diagnostic findings, or questions may arise after the original report. An addendum allows the examiner or reviewer to consider the new information, clarify earlier findings, or explain whether the original opinion has changed.

For example, an addendum may be requested when a new MRI report becomes available or when the original report does not fully address a specific medical question.

An addendum review supplements the original report rather than repeating the entire evaluation. A new examination may be necessary if the additional questions cannot be answered using the available information.

What Is Functional Capacity Evaluation (FCE) Coordination?

Functional Capacity Evaluation (FCE) coordination helps arrange an assessment of an injured worker’s physical abilities in relation to work-related activities.

An FCE is typically performed by a qualified rehabilitation professional, such as a physical therapist. The evaluator uses physical testing and simulated work activities to assess abilities such as lifting, carrying, pushing, pulling, standing, and walking.

FCE results provide information about an injured worker’s demonstrated physical abilities and tolerances. Medical professionals and claims teams may use the findings to inform work restrictions, accommodations, and return-to-work planning.

FCE coordination involves arranging the evaluation, communicating relevant requirements, and facilitating the evaluation process. The qualified evaluator conducts the physical assessment and documents the findings.

FCE coordination is appropriate when additional information about an injured worker’s physical abilities is needed to evaluate potential job duties or return-to-work options.

Choosing the Appropriate IME Service

Selecting the appropriate IME service starts with identifying the medical question that needs to be answered. Some claims require an independent medical exam, while others may only need a review of existing records, clarification of an earlier medical opinion, or an assessment of physical work abilities.

Understanding the differences between these services helps claims professionals obtain relevant medical information to support informed claims decisions.

Looking for a partner who offers a full range of IME services and can help determine which option best fits the needs of a claim? Connect with our team today.

Sources:

• California Department of Industrial Relations, Division of Workers’ Compensation. “Answers to Frequently Asked Questions about Qualified Medical Evaluators (QMEs) for Insurers.” California Department of Industrial Relations, Nov. 2025, https://www.dir.ca.gov/dwc/medicalunit/faqinsurer.html.
• California Department of Industrial Relations, Division of Workers’ Compensation. “Answers to Frequently Asked Questions about Qualified Medical Evaluators (QMEs) for Physicians.” California Department of Industrial Relations, https://www.dir.ca.gov/dwc/medicalunit/faqphys.html.
• California Department of Industrial Relations, Division of Workers’ Compensation. “Qualified Medical Evaluator Process.” California Department of Industrial Relations, July 2026, https://www.dir.ca.gov/dwc/MedicalUnit/QME_page.html.
• Texas Department of Insurance, Division of Workers’ Compensation. Texas Workers’ Compensation Rules: Texas Administrative Code, Title 28, Chapters 102–180. Updated 3 Feb. 2026, https://www.tdi.texas.gov/wc/rules/documents/wcrules.pdf.
• Texas Department of Insurance, Division of Workers’ Compensation. “Workers’ Compensation Insurance Glossary.” Texas Department of Insurance, https://www.tdi.texas.gov/wc/dwc/glossary.html.
• United States Department of Labor, Office of Workers’ Compensation Programs. “Vocational Rehabilitation Counselor Handbook: Part 4.” U.S. Department of Labor, https://www.dol.gov/agencies/owcp/FECA/regs/compliance/DFECfolio/RCHB/part4.
• WorkSafeBC. “Functional Capacity Evaluation.” WorkSafeBC, https://www.worksafebc.com/en/health-care-providers/rehabilitation/functional-capacity-evaluation.