What Makes an Independent Medical Exam Valuable?

In a claims environment where every expense is scrutinized, it’s natural to compare Independent Medical Exam (IME) vendors based on price. But here’s the reality: the IME fee itself is rarely the true cost driver.

There’s nothing wrong with pursuing efficiency. Many cost-effective IME programs deliver excellent work. Price alone does not determine quality.

The risk arises when cost becomes the primary decision factor, without fully evaluating how the exam is performed, how the report is built, and how the opinion will hold up under scrutiny.

Because if an independent medical exam results in:

• Late reports
• Addenda driven by incomplete record review
• Internal inconsistencies
• Weak or unsupported causation analysis
• Reports that fail to directly answer referral questions

…the cost doesn’t disappear. It shifts.

What may look like savings on the invoice can resurface as additional discovery, supplemental reports, expert depositions, prolonged indemnity exposure, or extended litigation timelines.

This raises a more strategic question: What actually makes an IME valuable?

Credibility in an Independent Medical Exam

A strong independent medical exam is defined by credibility. In litigation settings, research on expert witness performance consistently shows that credibility rests on a few core traits: subject-matter expertise, factual precision, neutrality, organized reasoning, and consistency between opinion and evidence. The same qualities that make an expert persuasive in court are the ones that make an independent medical exam defensible in a claim file.

Credibility is demonstrated through:

• Objective, impartial analysis: Conclusions grounded strictly in medical evidence.
• Comprehensive record review: A full evaluation of relevant medical records, diagnostics, and history.
• Direct responses to referral questions: Clear, structured answers to the issues the adjuster or attorney asked.
• Evidence-based reasoning: Opinions supported by recognized medical literature, clinical standards, and sound methodology.
• Clarity and organization: A report written in plain, structured language that a claims professional can readily understand.
• Internal consistency: Alignment between the reported history, physical findings, diagnosis, causation analysis, and work restrictions.
• Appropriate specialty matching and oversight: The right expert for the injury type, with quality assurance review before the report is finalized.

The AMA Guides to the Evaluation of Permanent Impairment emphasizes that credible medical-legal evaluations require a documented history, physical examination, and review of relevant records and diagnostic studies, delivered with fairness and impartiality. When those elements are rushed or diluted, credibility erodes. And once credibility erodes, cost escalates.

Example:

In Bermejo v. New York City Health & Hosps. Corp. (Supreme Court, Queens County, New York), an examining physician testified under oath that his IME lasted approximately 10–20 minutes. But video evidence showed the actual examination lasted just one minute and 56 seconds, a discrepancy that seriously undercut the doctor’s credibility and ultimately raised questions about the reliability of his opinion.

This case illustrates the broader point: when an independent medical exam is treated as a brief, volume-driven exercise rather than a thorough, transparent evaluation, both the physician’s credibility and the defensibility of the report suffer.

When an IME cannot withstand scrutiny, the impact is predictable: additional discovery, supplemental reports, expert depositions, prolonged trial exposure, and extended indemnity duration. In other words, a report that lacks credibility shifts from being a claim asset to a liability.

Structured Provider Network

Large-scale research from the National Council on Compensation Insurance (NCCI) comparing in-network and out-of-network workers’ compensation claims found something important: while medical payments were often similar, indemnity costs were consistently lower in claims managed within structured networks. Total incurred costs were approximately 3–5% lower in-network, with less variability across injury types.

The lesson isn’t that networks are automatically cheaper; it’s that structure influences outcomes.

When there is defined oversight, standardized processes, and coordinated management, claims tend to move more predictably. Variability decreases, indemnity exposure stabilizes, and outcomes become more consistent. IME programs operate under the same principle.

When an IME process includes:

• Appropriate specialty matching
• Centralized intake and referral review
• Clearly defined report timelines
• Quality assurance oversight
• Standardized documentation expectations

…the result is less variability in report quality and performance.

In claims management, reduced variability often translates into reduced risk, and ultimately, reduced cost.

Timeliness in an Independent Medical Exam

Turnaround time is essential, not just convenient (change wording). When an IME report is delayed, the impact extends beyond inconvenience. It can:

• Prolong temporary total disability exposure
• Delay settlement evaluation and positioning
• Extend litigation timelines
• Increase administrative handling

A timely, well-structured independent medical exam helps move a claim forward. It clarifies medical direction, informs reserves, and supports resolution strategy.

A delayed or incomplete report does the opposite. It introduces uncertainty. It pauses decision-making. It shifts momentum to the opposing side.

If a vendor’s lower fee is paired with inconsistent turnaround times, the savings are often offset elsewhere, such as indemnity duration, litigation management, or operational inefficiency.

In some jurisdictions, timeliness is not merely best practice; it is regulatory. For example, the California Division of Workers’ Compensation requires that comprehensive medical-legal evaluation reports be issued within 30 days of the examination. Missed deadlines can result in continuances, additional hearings, and extended exposure.

Final Thoughts

Instead of asking: “How much does this IME cost?”

Claims teams should consider asking:

• Will this report withstand cross-examination?
• Is the expert qualified, neutral, and credible?
• Does the report directly and clearly answer the referral questions?
• Is the analysis grounded in recognized medical evidence?
• Is turnaround time consistent and reliable?
• Is there structured oversight behind the process?

According to the National Safety Council, total worker injury costs reached $176.5 billion in 2023. In a system of that scale, the difference between a smooth claim and a prolonged one is significant.

When litigation costs are considered, a cost-effective IME has value, but a credible, timely, defensible IME is strategic.

Want to reduce risk, streamline claims, and get answers you can trust? Partner with Ethos for credible, structured IMEs delivered on time.

Check out our sources:

American Medical Association. AMA Guides to the Evaluation of Permanent Impairment Overview, AMA, https://www.ama-assn.org/practice-management/ama-guides/ama-guides-evaluation-permanent-impairment-overview.

Bermejo v. New York Health & Hosps. Corp., 2015 NY Slip Op 08374, New York State Unified Court System, https://www.nycourts.gov/REPORTER/3dseries/2015/2015_08374.htm.

California Division of Workers’ Compensation. Title 8, Section 38: Evaluation by Agreed Medical Examiner and Qualified Medical Evaluator, State of California, Department of Industrial Relations, https://www.dir.ca.gov/t8/38.html.

National Council on Compensation Insurance. Cost Impact of Medical Services on Workers Compensation Insurance, NCCI Holdings, Inc., https://www.ncci.com/Articles/Documents/Insights-CostImpactMedical.pdf.

National Institute of Justice. Important Traits That Enhance Expert Witness Credibility, NIJ, https://nij.ojp.gov/nij-hosted-online-training-courses/law-101-legal-guide-forensic-expert/trial/direct-examination/important-traits-that-enhance-expert-witness-credibility.

National Safety Council. Injury Facts: Work Injury Costs. National Safety Council, https://injuryfacts.nsc.org/work/costs/work-injury-costs/.