The Ethics Behind Independent Medical Exams

Independent Medical Exams (IMEs) play a pivotal role in Workers’ Compensation and liability claims. They’re designed to deliver an objective, expert medical opinion; yet in practice, IMEs often come under intense scrutiny. Injured workers may suspect bias, plaintiff attorneys frequently challenge impartiality, and even claims teams worry about whether an IME will hold up in litigation.

That skepticism is not without reason. Disputes over IMEs and medical opinions are trending upward. The California Workers’ Compensation Institute reported in 2024 that medical-legal disputes, including challenges to IME opinions, increased by more than 8% year-over-year. This is a sign that credibility concerns are growing. Additionally, the Workers Compensation Research Institute has noted that medical disputes are among the costliest delays in claims, often prolonging disability and driving litigation.

This environment makes ethics more than a compliance checkbox. Ethical independent medical exams are the bedrock of defensibility, trust, and claim resolution. Without impartiality, transparency, and adherence to professional standards, even the most clinically sound evaluation risks being discredited. For adjusters, legal teams, and medical providers, ensuring ethical integrity in IMEs is critical to managing costs, reducing disputes, and strengthening outcomes.

Defining Ethics in Independent Medical Exams

At its core, IME ethics comes down to four principles that shape whether an exam is credible and defensible:

• Impartiality: An IME physician’s role is not to advocate for either the insurer or the injured worker. Instead, the physician is tasked with delivering a fact-based medical opinion grounded in clinical evidence. The American Medical Association (AMA) underscores that independence is essential to protect the integrity of medical testimony.
• Objectivity: Ethical independent medical exams require findings based on clinical data, diagnostic results, and accepted medical standards, not on assumptions, payer expectations, or claimant narratives alone. The American College of Occupational and Environmental Medicine (ACOEM) highlights objectivity as critical to maintaining trust in independent evaluations.
• Informed consent: Injured workers must understand the purpose of the exam, what will take place, and their rights throughout the process. While an IME differs from a treatment encounter, ethical physicians ensure claimants know that the evaluation is being conducted to answer specific medical-legal questions, not to provide ongoing care.
• Confidentiality: Protecting sensitive medical information is both an ethical and legal obligation. HIPAA and state-level privacy laws govern how IME findings can be disclosed. Ethical providers release only the information necessary to address the referral questions, avoiding unnecessary sharing of unrelated medical details.

These principles are the baseline for ensuring IMEs withstand scrutiny. Without them, even a technically accurate medical opinion can be discredited in court, fueling disputes and prolonging claims.

Common Concerns

Even with clear standards in place, independent medical exams often face challenges that can damage trust and credibility:

• The “hired gun” perception: Injured workers and plaintiff attorneys may assume IME physicians are biased toward insurers. This skepticism is real: surveys from the National Academy of Social Insurance show that many workers do not trust physicians selected by insurers, with more than 40% expressing concern about impartiality. That perception alone can fuel disputes before a report is even reviewed.
• Pressure from insurers: While reputable IME providers emphasize independence, they may face subtle or direct pressure to reach conclusions that favor cost containment. Even the appearance of this dynamic can compromise the perceived neutrality of the report.
• Conflicts of interest: Prior consulting relationships with insurers, ongoing financial ties, or undisclosed affiliations can all undermine credibility. Courts have dismissed IME reports when conflicts of interest came to light, reinforcing how critical transparency is to defensibility.
• Poor communication: IME reports that rely on boilerplate language, skip over medical reasoning, or fail to explain how conclusions were reached are easy targets for cross-examination. Lack of clarity not only frustrates claims teams but also leaves room for attorneys to cast doubt on the entire evaluation.

Example

A 2020 Arizona Workers’ Compensation case, Torres v. Industrial Commission of Arizona, illustrates how ethical lapses can unravel the value of independent medical exams. In this case, the IME physician had extensive financial ties to the insurer that were not disclosed. Once the conflict came to light, the court dismissed the IME report entirely, ruling it unreliable. Beyond the wasted time and cost, the exclusion gave the claimant’s attorneys leverage in negotiations and damaged the credibility of the defense. This demonstrates that one flawed IME can derail an entire claim.

Standards for Independent Medical Exams

Thankfully, there are well-established guidelines designed to preserve objectivity and protect all stakeholders:

• AMA Code of Medical Ethics: The American Medical Association requires that physicians conducting independent medical exams remain impartial, base their conclusions on clinical evidence, and disclose any potential conflicts of interest. The AMA specifically notes that IME physicians are not treating providers. Rather, their obligation is to deliver an honest, evidence-driven assessment, not to advocate for any party.
• ACOEM Guidance: The American College of Occupational and Environmental Medicine emphasizes independence, informed consent, and adherence to evidence-based practices in independent evaluations. ACOEM further underscores the importance of clear, transparent communication in reports, which must explain medical reasoning in a way that withstands both regulatory and courtroom scrutiny.
• State regulations: Each jurisdiction layers in additional requirements. For example, California mandates that IME reports adhere to the state’s Medical Treatment Utilization Schedule, which defines standards of care. On the other hand, Texas requires that examiners be vetted and approved by the Division of Workers’ Compensation, ensuring only qualified physicians conduct official IMEs. Many states also require disclosure of prior insurer or claimant relationships to prevent conflicts of interest.

These standards protect not only patients but also examiners and claims teams by ensuring reports hold up under regulatory and legal scrutiny. An IME that complies with professional and regulatory guidelines is far more likely to hold up under legal scrutiny, withstand challenges from plaintiff attorneys, and ultimately strengthen the defensibility of the claim.

Best Practices for Ethical Independent Medical Exams

How can adjusters and legal teams spot the difference between a credible IME provider and one that could raise red flags?

1. Check credentials and specialization: The right expertise is important. A board-certified orthopedic surgeon brings far more weight in a complex spine injury case than a general practitioner. Specialized credentials not only strengthen credibility in court but also reduce the likelihood of disputes.
2. Review adherence to professional guidelines: Ethical providers should be able to clearly explain how the follow the AMA Code of Medical Ethics, ACOEM guidance, and state-specific requirements.
3. Watch for red flags: Overly fast turnaround times, templated or boilerplate reports, and a lack of disclosure on conflicts of interest can signal cutting corners. For example, California’s Department of Industrial Relations reports that the median IME turnaround is about 32 days. So, if a provider is promising a highly complex IME in less than half that time, it may come at the expense of thoroughness and accuracy.
4. Look for a quality assurance process: The most credible IME vendors invest in training, peer review, and report audits. According to the Coalition Against Insurance Fraud, quality assurance not only reduces disputes but also helps prevent fraud schemes that exploit weak medical opinions. Providers who can describe their QA process give claims teams added confidence that their reports will hold up under scrutiny.

Looking for an IME provider you can trust? Let’s talk. 

Check out our sources:

American College of Occupational and Environmental Medicine. ACOEM Guidance for Independent Medical Examinations. ACOEM, 2023. https://acoem.org/. 

American Medical Association. Code of Medical Ethics: Independent Medical Examinations. AMA, 2024. https://code-medical-ethics.ama-assn.org/.

California Workers’ Compensation Institute. Medical-Legal Dispute Trends in California Workers’ Compensation. 2024. https://www.cwci.org/.

California Department of Industrial Relations. Medical-Legal Evaluation Process and Timelines. DIR, 2024. https://www.dir.ca.gov/.

Coalition Against Insurance Fraud. The Impact of Medical Fraud on Claims Outcomes. CAIF, 2023. https://insurancefraud.org/.

National Academy of Social Insurance. Worker Perspectives on Independent Medical Examinations. NASI, 2022. https://www.nasi.org/.

Torres v. Industrial Commission of Arizona. 2020. Court of Appeals of Arizona. https://caselaw.findlaw.com/az-court-of-appeals/1917465.html.

Workers Compensation Research Institute. Resolving Medical Disputes in Workers’ Compensation. 2023. https://www.wcrinet.org/.