A Required Medical Examination (RME), sometimes called an Independent Medical Examination (IME), is a medical assessment performed at the request of a third party, not the patient’s treating physician. This non-treatment appointment is administrative or legal in nature. Its objective is to provide an objective medical opinion outside of the patient-physician relationship. The resulting report is used to make decisions regarding claims, benefits, or legal liability.
Context and Purpose of the RME
The RME is mandated when a financial or legal dispute exists regarding a person’s medical status. Workers’ compensation is a frequent scenario, where the employer’s insurer may request an RME to contest the severity of an injury, the necessity of proposed surgery, or the cause of the condition. The physician assesses whether the treatment being received is reasonable and medically supported.
The examination is also common in long-term disability claims, where the insurer needs to verify the claimant’s eligibility for continuing benefits. The doctor evaluates the claimant’s functional limitations and compares them against the policy’s definition of disability. RMEs are also a standard component of auto accident injury litigation, where the defense counsel or insurance company seeks an opinion to dispute the severity of injuries or argue that the condition is related to a pre-existing issue instead of the accident.
The RME offers an impartial assessment of the medical facts, though the physician is selected and compensated by the requesting party. This examination aims to determine the extent of injury, the prognosis, and whether the person has reached Maximum Medical Improvement (MMI). The assessment focuses solely on the claim or dispute, not on initiating or continuing medical treatment.
The Patient Experience During an RME
The RME process begins with the patient receiving a notice to attend, often with travel expenses covered by the requesting party. Patients should bring their medical records, imaging reports, and any assistive devices, as the examiner may not have a complete file. The patient must understand that the examiner is not their treating doctor and no doctor-patient confidentiality exists during the appointment.
The appointment itself is structured into a documentation review, a detailed interview, and a physical examination. During the interview, the doctor will ask about the patient’s medical history, current complaints, and how the condition affects their daily life. Patients should be truthful and accurate in their responses without exaggerating symptoms, as the examiner is trained to look for consistency between subjective complaints and objective physical findings.
During the physical examination, the doctor will assess functional limitations, range of motion, and strength, comparing the findings to clinical standards. Depending on jurisdictional laws, the patient may have the right to have an observer, such as a family member or attorney, present during the examination. In some cases, the patient may also be permitted to unobtrusively audio-record the examination, provided they disclose this to the physician beforehand.
The RME Report and Its Legal Impact
Following the RME, the examiner compiles a formal report detailing their findings, which is submitted to the requesting party. This medical-legal opinion addresses key questions, such as the relationship between the claimed injury and the event, the extent of permanent impairment, and the necessity of past or future treatments. The report may use standardized guides, like the American Medical Association’s Guides to the Evaluation of Permanent Impairment, to assign a specific impairment rating.
The report serves as a primary tool for the insurance company or opposing counsel to justify administrative decisions. A finding that an injury is not causally related to the incident or that a patient has reached MMI can be used to deny, modify, or terminate ongoing benefits or reject a claim for damages. Conversely, a favorable RME report can significantly strengthen a claim and facilitate a settlement.
If the RME report conflicts with the opinion of the patient’s treating physician, the treating physician’s records and expert testimony can be used to challenge the findings. In legal proceedings, the RME physician’s report is treated as expert evidence. The dispute between the two medical opinions may ultimately be resolved through negotiation, mediation, or a decision by a judge or commissioner. The patient or their representative has a right to review the final report to identify and contest any factual errors or disputed medical conclusions.