An Independent Medical Exam (IME) and utilization review (UR) are two ways an insurer can review whether treatment or a claim is reasonable and work-related. Neither is a final decision by itself, and disputed IME/UR overhaul details are not presented here as settled law — verify current rules against the IWCC. This guide is general information only — see the Disclaimer.
What is an IME?
An IME is an exam by a doctor who is not your treating doctor, usually chosen or paid by the insurer, to give an opinion about your injury, treatment, work ability, or whether you have reached maximum medical improvement. It is not the same as treatment — the IME doctor usually does not treat you.
What is utilization review?
Utilization review is a review of whether proposed or ongoing treatment, such as physical therapy, is reasonable and necessary. A UR decision can affect authorization, but it can be disputed. Keep the written decision and the reasons given.
How to prepare
- Bring a list of symptoms, medicines, and restrictions, and be accurate and consistent.
- Do not exaggerate or minimize symptoms.
- Ask for a copy of any report, and tell your treating doctor what was said.
- If benefits or treatment are stopped after an IME or UR, get it in writing and act quickly — see Claim denied.
If you disagree with an IME or UR result, consider talking with a lawyer promptly through Connect with a lawyer. This site does not promise an outcome.
Verify against the IWCC: Verify IME and utilization review rules against current IWCC guidance.
This page is general information only. It is not medical advice, not legal advice, and this site is not a law firm. See the Disclaimer.
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