Independent Medical Examinations (IMEs) FAQs

What is an IME?

An independent medical examination (IME), sometimes referred to as an independent medical evaluation, is a medical examination of an evaluee involved in a legal court action who reports physical or mental health injuries, or both. These evaluations should be conducted by well-trained physicians, who review relevant records (often thousands of pages), conduct an evaluation, write a thorough report and be available to testify about the findings in court. Forensicpsychiatry.com

Why are IMEs and expert testimony necessary?

Courts of many types rely on experts to provide information about people and events that is beyond the general knowledge of the public. Physicians from any field of medicine, including forensic psychiatrists, may be called upon to perform independent medical evaluations for the sole purpose of assisting legal decision makers in a variety of cases and venues: criminal and civil courts, personal injury claims, workers’ compensation cases, disability claims of many types, employment law issues, fitness for duty, infliction of emotional distress, contested wills and estates, and other important matters. The type of claim and the specific court venue matters because the rules are different. Physicians should be trained how to conduct IMEs before performing them. Both sides of a case require attorneys and possibly medical experts. Exceptions to this are benefit cases for social security and veterans’ disability where claimants and their attorneys address definitions and regulations without opposing counsel.  An independent medical examination (IME) and expert report are also useful in these cases.

Physicians from the clinical medical specialties may be contacted by attorneys in important legal matters, after a case has been filed in a court of law, which triggers procedural rules and deadlines. In state circuit courts alone, there are 66 million litigations filed each year, and these do not include administrative court cases, which are often about disability claims. Physicians willing to testify in a court become experts after a judge reviews their credentials and hears testimony about their education, training, and experience. The judge is the gate-keeper in all matters of expert testimony in any case.

In complex legal cases, there may be a dozen experts, and some will be non-physicians. The larger and more complex the case, the more likely several physicians will testify. The presiding judge will work to keep all the expert testimony narrowly tailored to the specific needs of the jury.

The foregoing explains why IMEs are needed and why physicians with specific medical training are contacted. People who become injured physically often have complaints of depressed and anxious moods with or without PTSD.  For this reason, forensic psychiatrists often testify in civil, criminal, and administrative courts. Forensic psychiatrists are preferred because of their additional training to become more useful in performing IMEs, writing reports, and giving reliable testimony in many types of court cases. All medical experts who are permitted to testify in court are presumed to possess knowledge beyond that of the jury in specific relevant matters. The entire purpose is to assist the work of judges and juries.

How are forensic psychiatric IMEs initiated?

An independent medical examination request to a forensic psychiatrist for a circuit court case begins with an inquiry from an attorney, who represents either the plaintiff or defendant. After brief introductions, the attorney gives a brief description of the legal case, and this is followed with questions about the physician’s education, training, experience and availability. The physician will ask about the type and number of records to be studied, where the case is filed, and deadlines. There will be important things to learn about the person to be evaluated, especially the language spoken by the evaluee, which if foreign to the physician will require that a competent translator be available for the IME. State boundaries also matter because all states independently license physicians, and forensic IME work is considered the practice of medicine even though it is not covered by health insurance. After the initial contact from the attorney, the physician sends their curriculum vitae (resume), fee letter agreement, and a tax document (IRS form W-9). Physician experts are paid by the hour and not on contingency, and all attorneys understand this. It is useful for the referring attorney to send a letter to the physician containing specific referral questions to be addressed in the IME report.

How are IMEs conducted?

Before conducting an IME, the physician receives the evaluee’s medical records (past and present), accident and injury reports, filings with the applicable court, witness statements, depositions, and reports of other experts. From these the expert physician formulates relevant questions to be asked in the IME.

The Independent medical examination date and location are scheduled through the requesting attorney’s office, and is often planned to last most of a working day with appropriate breaks and lunch. The person to be evaluated is not called a patient, but is an evaluee. The evaluee’s consent is obtained voluntarily after careful review of the consent document, and is signed. This document informs the evaluee that the IME doctor will not be their physician for treatment, that the information learned in the IME is not confidential, will be shared with the referring attorney in a report who will forward a copy to the evaluee’s counsel, and that the contents of the report could become public should the physician’s testimony be required in court. The evaluee can refuse to answer specific questions, and is able refuse to participate entirely, but these can have an adverse effect on the pending litigation. Records of many types can influence the IME. During the IME, the evaluee may ask for a short break at any time. It is important to see to the evaluee’s reasonable comfort because they often have complaints of musculoskeletal and headache pain, which is why calling for a five-minute break every hour, is wise.

The IME requires a clinical interview covering background, childhood development, education, work and social history, detailed medical, surgical, and mental health histories, allergies, medication dosages and prescriber names, account of the relevant injury and events that are the subject of the present litigation, legal history, comprehensive review of systems, mental status examination, inventories for cognition, depression, anxiety, PTSD, sleep, fatigue, and other subjects suggested by records and the specific claims found in the complaint. A directed physical examination with special attention to neurological function is often needed.

What are the components of the IME report?

The IME report is the logically written review of all the things accomplished in the IME process. The components include introduction, identification of the person evaluated, a brief discussion of the major issues, sources of information, medical record summary, mental health record summary, accounts of the subject event or accident, clinical interview, mental status examination, questionnaires and inventories utilized, symptom checklist, directed physical examination with neurological function, diagnostic formulations, and opinions. Throughout the IME report is an embedded medical analysis of the chronology of symptoms, diagnostic findings made by others, and the response to treatment efforts. Witness statements and deposition testimony are summarized if available. The IME report answers the referral questions of the retaining attorney. The report is worded plainly with medical terms briefly explained.

How are IME report opinions formulated?

The independent medical examination report will contain expert opinions logically derived from the careful analysis of the past and current medical and mental health records, the evaluation and the examination of the evaluee, a solid understanding of the causative events as claimed in the lawsuit complaint, and careful consideration of the expert opinions of others. The IME expert report must express opinions relevant to the court’s eventual determinations stated as clearly as possible within a reasonable degree of medical certainty (diagnostic certainty stated to a reasonable degree, greater than 50%).

Why IME expert reports may agree or disagree?

Two or more IME physicians will tend to agree or disagree on the basis of whether each reviewed identical past and present health records and conducted similar physical and neurological examinations. When these are similar, the opinions will probably be also, but when one expert reviews relevant records not available to the other expert, the opinions will likely be different. Each may come to different opinions based upon whether the alleged causative events are properly understood with regard to severity. It is also possible that two experts will not have been asked to opine on identical referral questions from the attorneys that employed each physician. Lastly, experts with different professional training probably should not be expected to offer identical IME opinions. Members of the general public who serve on juries will determine, as they should, how much weight to give any expert’s opinion in the case being adjudicated.

Summary statement about IMEs and testimony

The independent medical examination physician expert is a knowledgeable medical consultant employed only for purposes of litigation, who in the legal setting does not have the role of a treating physician, and the person undergoing the IME is an evaluee and not a patient. The expert IME physician remains respectful and reasonably sees to the comfort of the evaluee during the IME, within the bounds of propriety (the state of being proper, adhering to accepted standards of behavior, morals, and manners). The expert’s report and opinions are intended to be reliable for use as evidence in courts. This role has been deemed useful over several hundreds of years of jurisprudence in the U.S. and abroad.

Former FCC Employee Sentenced to one year in Alexandria Metro Station Assaults

From: The Alexandria Brief by Ryan Belmore, March 20,2026, A summary

The Circuit Court for the City of Alexandria, Virginia, finds that the defendant was in a state of delirium at the time of the attacks, driven by misprescribed medications and undiagnosed mental illness. The court found that misprescribed medications contributed to the defendant’s behavior on the night of May 30, 2025, and that he demonstrated genuine remorse. The defendant was arrested on June 1, 2025, and was fired from the FCC following his arrest. He faced two Class 5 felony counts of abduction by force or intimidation under Virginia Code 18.2-47 and one Class I misdemeanor count of sexual battery under Code 18.2-67.4. He entered a plea of no contest a few months earlier; therefore, the court held a sentencing hearing. A powerful victim impact statement was entered into the court record.

According to the forensic psychiatric testimony and the evaluation report filed with the court by Robert Brown Jr., M.D., the defendant consumed between $50 and $100 worth of alcohol at a bar between leaving work and approximately 8:30 p.m. on the night of the attacks. Dr. Brown wrote that the medications prescribed for the defendant, fluoxetine, buspirone, and dextroamphetamine - combined with excessive alcohol ingestion would be expected to produce a delirium, which Dr. Brown described as a disturbance of attention and cognition developing over a short period of time along with memory deficit, disorientation and impaired perception. Dr. Brown also testified that the defendant suffered from bipolar I disorder, which was not properly recognized or treated before May 30, 2025, meaning that he was not on appropriate medications for that serious mental disorder at the time of the offenses.  Forensicpsychiatry.com