An independent medical exam sounds neutral. It rarely is. If you were injured in a crash and filed an insurance claim or lawsuit, chances are the defense will schedule an “IME,” typically paid for by the insurer and performed by a doctor they chose. You can still handle it well. Preparation and realistic expectations go a long way, and the details matter more than most people think.
I have sat with clients in waiting rooms where the doctor’s name rang bells in the local plaintiff’s bar. Some physicians have examined hundreds of claimants for insurers, often concluding that injuries are minor, temporary, or unrelated to the wreck. That pattern does not mean your case is doomed. It does mean you should approach the exam with a plan, and with the same care you give to depositions, mediation, and trial preparation. A car accident lawyer or car accident attorney will always treat this appointment as a critical piece of the evidence puzzle.
Why insurers demand IMEs
Insurance adjusters want to limit exposure. A treating physician usually focuses on healing, pain management, and function. The defense doctor’s role is different. They review records with an eye toward alternative causes and gaps in treatment, then write a report insurers can cite when negotiating or defending at trial. In some states, defense counsel needs a court order for an exam, and the scope is limited by the rules. In others, your own policy’s personal injury protection benefits may entitle the insurer to an exam as a condition of continued payment. Either way, the insurer wants an outside opinion to challenge causation and the extent of injuries.
From experience, there are three common push points. First, degenerative findings on imaging, especially in the spine. Second, prior injuries or unrelated past medical complaints that sound similar, even if they were minor or resolved years ago. Third, treatment choices that look “aggressive,” like multiple injections or a surgery recommendation within weeks of the crash. The defense doctor’s report will often highlight those areas.
Who this doctor is, and why that matters
The label “independent” is misleading. Many IME physicians derive meaningful revenue from defense referrals. Some testify frequently. That does not automatically discredit them, but it shapes how they approach exams. In orthopedic and neurology IMEs, I have seen tightly scripted routines, timed strength tests, and a heavy reliance on objective metrics like reflexes and range of motion. Pain specialists may focus on Waddell’s signs or symptom magnification. Psych IMEs are different again, often centering on standardized questionnaires and a long interview.
Your attorney may already know the doctor’s track record. If the same surgeon has issued “resolved sprain” opinions in dozens of cases, that context informs strategy. A seasoned car accident attorney will collect a short dossier on the examiner: specialty, publications, how often they testify, and any court decisions discussing their opinions. That background helps predict the lines of questioning and what details the report will emphasize.
Logistics that shape the day
Plan for more time than the notice suggests. Appointments frequently run late because the doctor books multiple claimants back to back. The office rarely operates like a primary care clinic. Don’t take medication that your treating physician has told you to avoid before exams, and don’t change your routine otherwise. Wear clothing that allows a physical exam: shorts under sweats, a top you can move in. Bring a photo ID, the appointment notice, and any items your attorney asked you to carry, like a brace you regularly use.
Transportation matters. If your injuries limit driving, arrange a ride. Taxis or rideshares also sidestep the inevitable parking scramble near medical office parks. If you use a cane, orthotics, or other assistive devices daily, bring them and use them as you normally would. Inconsistent behavior is a common theme in IME reports. If you limp into the clinic then walk out briskly while looking at your phone, expect to see that contradiction in print later.
The check-in process and paperwork traps
New patient packets at IMEs often include broad medical releases. The forms may look routine, but they can grant the defense access to years of records unrelated to your crash. Your lawyer should review or pre-authorize what you can sign. As a rule, stick to the basics: confirm identity, insurance claim information, and acknowledge the appointment. If staff hand you questionnaires about prior conditions, fill them out honestly without guessing. It is acceptable to write “uncertain” and avoid providing dates you cannot remember. Do not volunteer opinions on fault or describe the crash mechanics beyond concise answers if asked. The exam’s purpose is your medical status, not liability.
Keep your own record. Note the time you arrived, the time you were called back, when the doctor entered, and when the exam ended. Write down who was present. Courts have allowed these timeline notes to refresh a witness’s memory, and they can matter if the report claims a 45-minute detailed exam that lasted 12 minutes.
Whether your attorney can attend or record
Rules vary by state and by court order. In some jurisdictions, a lawyer or neutral observer can attend physical exams. In others, they cannot be in the room but may be nearby. Audio recording is sometimes allowed for psychological evaluations, sometimes for physical exams, and sometimes prohibited. Your attorney should seek agreement or a court ruling beforehand. Where recording is permitted, it tends to reduce disputes about what was asked and answered. Where it is not permitted, the next best thing is a thorough post-exam debrief while details are top personal injury attorneys fresh.
If attendance is allowed, the lawyer’s role is quiet and watchful. No coaching, no objections to medical testing unless the doctor veers into prohibited areas, like questions about legal strategy. A brief pre-exam stipulation can help: what tests are permitted, the expected duration, any imaging planned, and whether invasive procedures are off the table. Defense doctors generally cannot perform injections, manipulation under anesthesia, or other invasive measures without consent and prior court approval.
What actually happens in a physical IME
The structure is familiar across specialties. The doctor will review your history, often with a pointed focus on prior injuries. Then comes the exam: inspection, palpation, range of motion, neurologic testing, and specialized maneuvers. Expect the doctor to test for pain behavior and consistency. They may repeat the same motion measurements at different times to check for reproducibility. Strength tests can be done in ways that detect submaximal effort. For spine cases, reflex hammers, pinprick sensation checks, and straight-leg raise tests are routine. For shoulder injuries, look for impingement signs and rotator cuff testing. Knee exams might include Lachman and McMurray maneuvers. The doctor might ask you to walk, toe- and heel-walk, or squat.
Imaging is often reviewed rather than performed. Some clinics take in-house X-rays. If the doctor wants fresh films and your counsel has not approved that, you have the right to pause and call your attorney. Most courts limit IMEs to noninvasive testing unless previously agreed. Bring prior imaging reports and studies if your attorney tells you to. Otherwise, the doctor should already have the records from defense counsel.
Throughout, answer questions truthfully and narrowly. If asked about daily activities, describe your actual limitations with examples. “I can stand for 15 to 20 minutes before my lower back stiffens and pain hits a 6 out of 10. I sit with a cushion and change positions every half hour.” Specificity beats vague adjectives. Avoid minimizing bad days or exaggerating good ones. Consistency with your treatment notes matters. If you told your physical therapist that you struggled to lift a gallon of milk, keep that anchor when you describe household tasks.
Psychological IMEs: a different cadence
When cases involve PTSD, depression, or cognitive complaints after a concussion, expect a long interview and standardized testing like the MMPI-2, PAI, or symptom validity measures. Some tests are designed to detect over-reporting or under-reporting. These are not intelligence tests in the way people imagine, but they can flag inconsistent patterns. Be prepared for probing questions about prior mental health, substance use, family history, and past traumas. The scope often feels intrusive. Your car accident lawyer should outline what areas are fair game and challenge anything that strays far from the claimed injuries or reasonable background.
In these exams, fatigue plays a role. Testing can take several hours. Ask for breaks when needed, and take them. Your performance late in the day should not suffer simply because you were too polite to pause, only to face a report that frames declining results as effort-dependent.
The report: what it includes and how it is used
IME reports tend to follow a formula. They open with records reviewed, then document history as told by the patient, followed by physical findings, test results, and opinions. Be ready for language that leans on probabilities: “within a reasonable degree of medical certainty,” “more likely than not,” or “inconsistent with objective findings.” Common defense conclusions include temporary soft-tissue strain resolved within X weeks, degenerative cervical spondylosis unrelated to the crash, and maximal medical improvement by a date earlier than your treating doctor supports.
Lawyers read these reports with a highlighter and a red pen. They compare the “history” section to what you remember saying. Omissions or misstatements can be pivotal. If the report says you denied numbness, but you clearly described intermittent tingling, your attorney can correct that in a rebuttal or cross-examination. Objective measurements are another focus. If range of motion is measured far less than your physical therapist recorded the same week, that discrepancy needs context. Sometimes the explanation is simple, like a bad pain day. Other times, it shows selective recording.
The report will be used to contest ongoing treatment, undermine claimed future medical costs, and challenge lost earning capacity. Insurers may cut off benefits based on it. In litigation, the examiner might testify at deposition and trial. A seasoned car accident attorney will be ready with the doctor’s prior testimony excerpts and peer-reviewed literature to test their methodology.
How to talk during the exam without hurting your case
You do not need to be a robot, but precision helps. Avoid jokes that can be misinterpreted. Avoid absolute statements. “I can never lift more than 5 pounds” invites impeachment if a social photo shows you holding a toddler. Describe ranges and patterns. Pain scales are imperfect tools; anchor them to function. For example, “A 7 is when I cannot finish basic chores and I lie down with a heating pad. Most afternoons hover around a 4 if I pace myself.”
Do not guess at prior dates, dosages, or medical terminology. If you are unsure, say so. Do not volunteer opinions on causation, biomechanics, or legal issues. That is not your role. If the doctor asks how the crash happened, answer factually and briefly: “Rear-ended while stopped at a light. The other car was traveling around 25 to 30 mph per the police report.” If they press for more, it is reasonable to say you are there to discuss medical issues and that other details will come through counsel.
Red flags to watch for during the exam
Some behaviors hint at where the report may go. If the doctor spends far more time on your old records than on examining you, expect a causation challenge. If they repeatedly ask whether you “really need” ongoing therapy or medication, they may dispute medical necessity. If they test the same movement multiple times with sudden speed or surprise, they may be checking for guarding or inconsistency. Stay steady. Perform to the best of your ability, no more, no less.
Occasionally, the physician will perform tests without explaining what they are checking. You can ask for plain language. “What does this test measure?” You are not cross-examining; you are seeking understanding. A measured tone helps. Also, do not agree to pain levels you do not feel in the moment just to be agreeable. It is acceptable to say “That movement hurts more than the last one” or “That tingles but does not hurt.”
After the exam: what to record while it’s fresh
As soon as you leave, capture details. Write down the questions you were asked, the tests performed, how long it took, and any remarks the doctor made. If they mentioned alternative causes, like “degenerative changes likely explain your pain,” note the phrasing. These notes help your attorney frame a rebuttal or decide whether to request an addendum, a supplemental exam with your own expert, or a motion to limit the IME testimony.
If you felt worse afterward, document that too. Some exam maneuvers can flare symptoms. Track duration and intensity for the next day or two. This is not to manufacture claims but to give a clear picture. Should the defense argue that the exam was benign and your pain is exaggerated, contemporaneous notes carry weight.
How your lawyer counters a negative IME
Defense reports are not the final word. There are established ways to respond:
- Treating physician rebuttal letters that address specific points, such as why imaging supports acute injury on top of degeneration, or why functional testing aligns with ongoing limitations. Comparative timelines showing a pre-crash baseline with no treatment for years, then consistent post-crash care, which supports causation by sequence and response to treatment.
IME depositions are where much of the air comes out of sweeping statements. Skilled questioning pins down how much time the doctor spent, what literature they relied on, whether their opinions have changed when confronted with new data, and how often they testify for insurance companies versus injured people. Jurors often care about those ratios. A car accident lawyer who handles these cases regularly will also bring out concessions, such as acknowledging that trauma can aggravate dormant degenerative conditions, or that pain without imaging changes can still be real and disabling.
The special problem of degenerative findings
MRIs of people over 40 frequently show wear and tear: disc bulges, facet arthropathy, osteophytes. Defense doctors lean on this to argue your pain is not from the crash. The law in many states recognizes aggravation of preexisting conditions. The medical question becomes whether the collision lit up an asymptomatic condition or accelerated its course. Clues include a clean gap of time with no prior treatment, a sharp onset of symptoms after the wreck, and persistent, well-documented complaints that correlate with the mechanism of injury.
I have seen jurors connect the dots when presented with simple, grounded evidence: a primary care note two months before the crash documenting full activity, then a steady march of physical therapy, injections, and work restrictions afterward. Keep your records consistent and honest, and this argument becomes manageable rather than fatal.
Navigating no-show risks and rescheduling
Missing an IME can jeopardize your claim, especially when policy benefits depend on compliance. If a conflict arises, contact your attorney promptly. Courts and insurers will usually allow a reschedule if you provide advance notice and a valid reason. Transportation issues, acute illness, or a conflicting medical appointment can be addressed. Silent no-shows, by contrast, play into the narrative that you are not cooperating.
If the date was set without reasonable notice or the location is unreasonably far, your attorney can object and propose alternatives. Reasonableness is the touchstone: distance, timing, and your medical limitations all feed into that assessment.
The rare but real issue of unsafe or inappropriate testing
Most IMEs are straightforward, if uncomfortable. Once in a while, a doctor attempts an invasive procedure or aggressive manipulation that exceeds the exam’s scope. You can decline. Polite firmness works: “I am not comfortable with that procedure today. I will consult my attorney before consenting.” If the doctor insists, step out and call your lawyer. Your health comes first, and courts do not expect you to undergo procedures that carry risk without a prior agreement.
Working with your treating providers before and after
Let your treating doctor know about the IME. They may adjust your therapy schedule to avoid flaring symptoms the day before. Afterward, tell them how it went, especially if your pain increased or you noticed new symptoms. Objective findings from your provider in the days following can counter claims that you were fully recovered at the time of the IME.
Be careful not to let the IME intimidate you into stopping helpful care. Insurers sometimes terminate benefits based on the report. If your provider recommends continuing therapy or medication, discuss options with your attorney. There may be medical payment coverage, health insurance, or a lien arrangement that allows treatment to continue while the dispute plays out.
Social media and surveillance around IMEs
Insurers often schedule surveillance around key events, including the day of the IME. Do not stage anything. Do not avoid daily activities you genuinely perform. Also, do not push beyond your limits because you feel watched. Simply live within your restrictions. If you must carry groceries, take multiple lighter bags. If you need a break after walking from the car, take it. Surveillance video rarely captures context, so provide your own in how you move and manage tasks.
As for social media, assume defense counsel will see anything public. A smiling photo at a family gathering does not sink a case by itself, but captions like “pain-free at last” will be quoted out of context. Keep posts neutral or refrain while litigation is pending.
Practical, compact prep checklist
- Review your symptoms and limitations with your attorney a day or two before, so your descriptions are clear and consistent. Gather IDs, any required paperwork, and assistive devices you normally use. Plan transport and arrive early enough to complete forms without rushing. Bring a notepad to record times and observations after the exam. Afterward, debrief your lawyer promptly while details are fresh.
What success looks like
A “successful” IME does not mean the doctor agrees with everything you claim. It means the exam does not blow up your credibility, and the report leaves room for your treating providers and your own experts to carry the day. Over time, I have watched measured, consistent patients beat harsh IME opinions because jurors and judges believed the person living with the injury, not the once-off examiner. Clarity, steadiness, and preparation made the difference.
If you take away one core principle, let it be this: you cannot control the examiner’s incentives, but you can control how you present your story. Show up as the same person your medical records describe, with the same limitations your daily life reflects. That alignment is powerful.
When to bring in your own examiner
In cases with major injuries or contested causation, your lawyer may hire a consulting expert to perform a plaintiff’s medical exam and produce a report. It is not cheap. Orthopedic or neurology evaluations with records review and deposition time can run into the thousands. auto injury lawyers But if the defense IME is particularly aggressive, a well-credentialed treating surgeon or independent expert can neutralize it. The decision is strategic, based on case value, jury pool tendencies, and the defense doctor’s reputation.
Final perspective
Independent medical exams are not the moment to win your case. They are the moment to avoid losing ground needlessly. Treat the appointment with the respect you give any legal proceeding. Prepare with your car accident attorney, follow the guardrails, and document what happens. Most importantly, be yourself. Not the best version, not the worst. The true version that aligns with the records and the reality of your day-to-day life. That is what endures when reports, motions, and testimony begin to pile up.