IME Medical Examination in California: Workers' Comp, Personal Injury and Federal Cases

An IME medical examination is an evaluation by a physician who does not treat the person examined. The physician reviews the records, takes a history and examines the body parts at issue. Then the physician writes a report for the party or agency that asked for it. OrthoLegal coordinates orthopaedic IMEs across California for personal injury cases, employer-requested workers’ comp exams and federal Department of Labor claims.

The rules differ by system. This page explains where an IME fits in California workers’ comp. It also covers how a personal injury IME is demanded, how federal exams work and what the report contains. Finally, it compares an IME with a QME or AME.

Where does an IME fit in California workers' comp?

In a California workers’ comp claim, the medical-legal evaluation of a disputed issue does not come from an IME. It comes from a Qualified Medical Evaluator (QME) or an Agreed Medical Evaluator (AME). Under Labor Code sections 4061 and 4062, a disagreement over the treating physician’s opinion goes to a QME panel. Alternatively, the parties agree on an AME.

So when does an IME workers’ comp exam happen in California? In two situations. First, Labor Code section 4050 lets the employer ask, in writing, that the injured worker attend periodic examinations. The employer provides and pays for the physician. The worker may bring a physician of their own, at their own expense (section 4052). If the worker refuses or obstructs the exam, section 4053 suspends the right to begin or maintain a claim while the refusal continues.

Second, Labor Code section 4064 says that no party is prohibited from obtaining a medical evaluation at its own expense. People sometimes call that evaluation an IME. Still, the medical-legal report the parties rely on before the Workers’ Compensation Appeals Board comes from the QME or AME process.

For the evaluator, the exam looks the same: history, records, examination, report. The difference is who asked for it, who pays and what the report can be used for. Our Qualified Medical Evaluator page and Agreed Medical Evaluator page cover the panel and agreed routes.

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How does an IME work in a California personal injury case?

In a personal injury lawsuit, a defendant may demand one physical examination of a plaintiff who claims injury. No court order is needed (Code of Civil Procedure section 2032.220). The demand names the physician and the specialty. The exam must take place within 75 miles of the plaintiff’s residence, with no painful, protracted or intrusive test.

Any further physical exam, and any mental exam, needs leave of court (section 2032.310). The plaintiff’s attorney may attend the physical exam and record what is said (section 2032.510). So may a representative the attorney authorizes in writing. Neither may take part in the exam or disrupt it.

Orthopaedic personal injury claims usually involve fractures, spine injuries, joint trauma and post-surgical impairment. Most come from motor vehicle collisions, falls and premises incidents. The IME physician links the mechanism of the incident to the diagnosed condition and separates acute findings from pre-existing degenerative change. The opinion is stated within a reasonable degree of medical probability.

How do IMEs work in federal workers' compensation claims?

Federal employees’ work injury claims fall under the Federal Employees’ Compensation Act (FECA). The Office of Workers’ Compensation Programs (OWCP) in the U.S. Department of Labor administers it, and OWCP, not the parties, directs the examinations. It may order a second opinion examination by a physician in the appropriate specialty.

The employee must attend any exam OWCP considers reasonably necessary (20 CFR 10.320).

Sometimes the two physicians reach opposing conclusions in reports of virtually equal weight. Then OWCP appoints a referee physician, qualified in the appropriate specialty and with no prior connection to the case (20 CFR 10.321). OWCP pays second opinion and referee physicians directly. It also reimburses the employee’s necessary travel costs and lost wages (10.322). Refusing or obstructing a directed exam suspends compensation until the refusal stops (10.323).

Our Department of Labor cases page describes OrthoLegal’s federal evaluation work and the OWCP reporting standards.

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IME vs QME vs AME: who selects the physician?

The three evaluations differ in who selects the physician and where each applies. The requesting party or agency chooses an IME physician. That is the defendant in a personal injury case, the employer under Labor Code section 4050, or OWCP in a federal claim.

By contrast, a QME comes from a three-name panel the Division of Workers’ Compensation (DWC) issues, and both sides agree on an AME.

That difference carries through to the report. A QME serves the report on the worker, the claims administrator and their attorneys at the same time (Title 8, section 41). The report is due within 30 days of the exam (section 38). After a personal injury IME, the party that arranged the exam holds the report, and the examinee’s side can demand a copy. In a federal claim, OWCP receives the report and weighs it against the other medical evidence.

Whether an IME physician is “neutral” depends on the system, so this page does not use the word. Every system requires the same thing: an opinion based on the records, the history and the examination, with the reasoning written out.

What happens at an IME medical examination?

An orthopaedic IME medical examination has four parts. First comes check-in, then a history of the injury and treatment. Next, the physician reviews the records and imaging provided. Finally, the physician examines the body parts at issue and documents measured findings such as range of motion, strength, sensation, reflexes, joint stability and gait.

There is no treatment, and no doctor-patient relationship begins.

The length of the visit depends on the case. It runs longer when several body parts are in question, the history is complex or the records are extensive. The scheduling notice gives the expected time. The examinee should bring identification and any imaging on disc that the requesting party has not already sent.

What does the IME report contain?

An IME report sets out the history taken at the exam, the records and imaging reviewed, the examination findings with measurements and the diagnosis. Then it gives the physician’s reasoned answers to the questions posed: cause, work capacity, future medical care and impairment. It lists what was reviewed, so a reader can check each opinion against the records.

In a California civil case, the examined side may demand a detailed written report. It covers the history, examinations, findings including test results, diagnoses, prognoses and conclusions. Delivery is due within 30 days after the demand, or 15 days before trial, whichever is earlier (Code of Civil Procedure section 2032.610). For federal claims, OWCP bases its decision on the opinion with more probative value (20 CFR 10.321). So the report’s reasoning decides how much weight it gets.

How do I request an orthopaedic IME from OrthoLegal?

Attorneys, claims administrators and employers request orthopaedic IMEs through OrthoLegal’s team. Tell us the type of case, the body parts at issue, the city nearest the examinee and the deadline. We then match the case to a board-certified orthopaedic surgeon in the right subspecialty.

Next, we schedule the exam at one of our evaluation locations across California. We also collect the records and deliver the report to the requesting party.

The physician directory shows each surgeon’s subspecialty and the regions where they evaluate. Every profile has an appointment request form.

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Can orthopaedic surgeons add IME work to their practice?

Yes. IME work needs board certification, an active California medical license and clinical experience with the injury patterns being evaluated. Working knowledge of the AMA Guides and prior medical-legal reporting makes a report more usable. Exams fit into block sessions, involve no treatment or follow-up, and sit beside a surgical or clinic practice.

OrthoLegal handles the scheduling, records and attorney coordination for its physicians. Its DWC-approved Report Writing Course covers the reporting standards. See our page for physicians to get started.

FREQUENTLY ASKED QUESTIONS

What is an IME in workers' comp?

In California workers’ comp, the medical-legal evaluation of a disputed issue comes from a QME or an AME, not an IME. Instead, the term IME usually means a personal injury exam or a federal FECA second opinion or referee exam. It also covers an employer-requested exam under Labor Code section 4050, which the employer provides and pays for.

The length varies with the case. An orthopaedic IME medical examination runs longer when the history is complex, several body parts are in question or the records are extensive. Record review and the written report take more of the physician’s time than the visit itself. Before the visit, the scheduling notice gives the expected time.

It depends on the system. In a California personal injury case, the defendant names the physician in the demand (Code of Civil Procedure section 2032.220). In a federal FECA claim, OWCP selects the second opinion or referee physician. For an employer-requested exam under Labor Code section 4050, the employer provides the physician.

The IME physician reviews the medical records, imaging and prior reports provided, the history given at the examination and the examination findings. Then the physician answers the questions posed: diagnosis, cause, work capacity, future care and impairment. The report lists what was reviewed, so readers can check each opinion against the records.

OrthoLegal coordinates orthopaedic IMEs at evaluation sites across Northern, Central and Southern California. Attorneys and claims professionals can request an evaluation through our For Applicants and Attorneys page or by calling 213.947.0000. Our physician directory shows each surgeon’s subspecialty and the regions where they evaluate.

A plaintiff expert is retained by the injured party to support claims of injury, causation, and damages, while a defense expert is retained by the responding party to challenge those claims, identify alternate causes, or minimize the extent of damages. Both experts must remain objective and base their opinions on the medical record and accepted methodology. In orthopaedic cases, plaintiff and defense experts often dispute whether an injury was caused by the incident at issue or by pre-existing degenerative changes.

An orthopaedic independent medical examination (IME) involves a thorough review of medical records and diagnostic imaging, a detailed history of the incident and current symptoms, and a hands-on physical examination assessing range of motion, strength, joint stability, neurological function, and gait. The physician then issues a written report addressing diagnosis, causation, prognosis, need for future treatment, and any impairment under applicable guidelines. The IME does not establish a doctor-patient relationship and is purely evaluative in nature.

Physicians are typically selected as expert witnesses based on board certification, subspecialty fit, clinical and academic experience, prior medical-legal work, and performance in deposition and trial testimony. In orthopaedic personal injury cases, attorneys consider the expert’s familiarity with the specific body part and mechanism of injury, command of the relevant imaging, and ability to communicate clearly to a jury. Many attorneys rely on internal lists, referral networks, and prior case experience when retaining experts.

Orthopaedic physicians evaluate injuries such as cervical and lumbar spine trauma, disc herniations, fractures, joint dislocations, ACL and meniscus tears, rotator cuff injuries, shoulder labral tears, and post-surgical complications. They handle injuries from motor vehicle collisions, slip and falls, sports injuries, premises liability incidents, and assaults. Their evaluations focus on linking the mechanism of injury to the diagnosed condition and quantifying the resulting functional impact.

Causation in an orthopaedic personal injury case is established by linking the mechanism of the incident to the diagnosed musculoskeletal injury through medical records, imaging studies, the timing and pattern of symptoms, and the physician’s clinical judgment. Experts often distinguish acute traumatic findings from pre-existing degenerative changes and consider biomechanical factors and the patient’s prior medical history. The opinion must be expressed within a reasonable degree of medical probability to be admissible.

Orthopaedic physicians may be required to testify at deposition or trial in personal injury cases, particularly when their opinions on causation, diagnosis, treatment, prognosis, or impairment are contested. Testimony allows experts to explain complex musculoskeletal concepts, interpret imaging, and respond to cross-examination from opposing counsel. The frequency and depth of testimony depend on case complexity, the strength of the medical evidence, and whether the matter settles before trial.

An orthopaedic medical-legal report typically includes the patient history, mechanism of injury, review of medical records and imaging, physical examination findings, diagnosis, and the physician’s opinions on causation, prognosis, future medical needs, and impairment. Reports often address apportionment between the incident at issue and pre-existing or non-related conditions. A well-prepared report is clear, evidence-based, and structured to withstand cross-examination.

A treating physician provides ongoing care, manages treatment, and develops a doctor-patient relationship, while an IME physician is retained to issue an opinion without providing treatment. Treating physicians have detailed longitudinal knowledge of the patient’s progress, but IME physicians offer an independent assessment of diagnosis, causation, and impairment for litigation purposes. Both can serve as experts in a personal injury case, though their roles, scope, and relationship with the patient differ.

Medical damages in an orthopaedic personal injury case are assessed by reviewing past medical bills, imaging and procedure costs, and the projected expense of future medical care, including additional surgeries, physical therapy, injections, and medications. Experts may rely on life-care planners and economists to quantify long-term costs. They also evaluate functional limitations, lost earning capacity, and quality-of-life impacts stemming from the orthopaedic injury.

A qualified expert is typically board certified, actively practicing, and experienced in the relevant injury patterns and body regions. Strong experts also demonstrate command of medical legal standards, imaging interpretation, and AMA Guides based impairment analysis. Consistency, clarity, and deposition reliability are key differentiators in selection.

Personal injury cases are civil claims based on negligence, requiring proof that another party caused the injury and resulting damages. Workers’ compensation is a no fault system under the California Labor Code that provides defined benefits for work related injuries regardless of fault. Both involve orthopaedic evaluation, but they differ in legal process, evidentiary standards, and how benefits and compensation are determined.

Request an orthopaedic IME

OrthoLegal coordinates independent medical examinations, QME and AME evaluations, SIBTF evaluations and fitness for duty exams. Orthopaedic surgeons perform them at sites across California. To request an IME, use the form on our page for applicants and attorneys or call 213.947.0000.

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This page is general information about independent medical examinations, not legal advice. For a specific case, refer to the current statutes and regulations or consult counsel.

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