An IME rating review should connect five elements: the governing framework, its edition or version, the supporting medical evidence, the calculation, and the legal meaning of the result. Start with those elements before relying on the percentage in a case assessment, settlement analysis, or examination outline.
For attorneys, insurance defense firms, and corporate legal departments, the practical question is whether the report adequately explains its conclusions for the issue presented. A precise number deserves the same scrutiny as the medical reasoning behind it.
Identify What the IME Rating Actually Measures
For more context, review physician expert witness qualifications.
Separate Medical Impairment From Disability and Benefits
Do not use “impairment,” “disability,” and “benefits” interchangeably in your review notes. California treats medical impairment as an input to its permanent disability formula, while New York expressly distinguishes impairment from loss of wage-earning capacity, as discussed below. These are jurisdiction-specific distinctions, not nationwide conversion rules.
Confirm the Jurisdiction, Injury Date, and Rating Standard
Check the Applicable Rules Before Reviewing the Arithmetic
Record the jurisdiction, claim context, injury date, applicable schedule, and relevant effective-date provisions at the top of your review worksheet. Do not assume that a workers’ compensation methodology answers a question presented under a different claim framework.
The AMA’s Guides Sixth 2025 overview advises evaluators to review state and jurisdictional requirements concerning use of its Guides. Publication of a newer version does not establish that it governs the evaluation before you. Resolve applicability separately from whether the examiner accurately followed the identified method.
Identify the Exact AMA Guides Edition and Version
A reference to “the Sixth Edition” may not identify the methodology precisely enough. The AMA describes the 2008 Sixth Edition as the foundation for subsequent cumulative updates. Ask which version the examiner used and distinguish that answer from whether the version applies to the claim.
Check the cited chapters, tables, methods, and updates against the stated framework. If the narrative names one version but the calculation references another, request an explanation before treating the discrepancy as either harmless or outcome-determinative.
Review the Medical Report Beyond Its Final Percentage
A 1999 AAPC article (Maximize Reimbursement for IMEs) described a non-treating physician disability examination as including history, examination, diagnosis, capabilities, stability, impairment calculation, future treatment planning, and documentation. That historical coding discussion offers a useful completeness checklist, not a current universal legal reporting standard.
Connect the Records Reviewed to the Diagnosis
Check whether the report identifies the records actually reviewed and connects the relevant history to the diagnosis. Compare injury dates, treatment dates, prior symptoms, operative history, and diagnostic studies with the source documents.
For a postoperative knee evaluation, determine whether the examiner reviewed the operative report or relied only on a later summary. If a relevant document is missing, ask whether reviewing it could affect the opinion. Addressing those gaps before examination is also a useful focus of pre-IME preparation for attorneys.
Look for documented findings supporting functional opinions. A restriction against lifting above shoulder level should have an explained medical basis, rather than appearing only in the conclusion. Keep reported symptoms, observed findings, and the examiner’s interpretation separate in your notes. If the report addresses a specific job, identify the job description or task information considered.
Review stability, prognosis, and anticipated care together. If the examiner describes further treatment while assigning permanent impairment, ask how those opinions fit together under the applicable framework. Do not assume that any planned treatment necessarily precludes permanence.
Examine the Basis for Permanency and Clinical Support
Locate the Reasoning for MMI and Causal Relationship
In its permanency guidance, the New York Workers’ Compensation Board identifies maximum medical improvement and a causally related permanent impairment as the starting point for assessing schedule and non-schedule permanent disabilities. Apply that example within its jurisdictional context, not as a universal IME requirement.
Where those opinions are relevant, locate the supporting explanation, not merely the checked box. If the examiner identifies an MMI date, ask which clinical events or findings support that date and how the report addresses causation separately from severity.
Reconcile Clinical Findings and Diagnostic Evidence
The New York WCB guidance directs providers to document the history, physical findings, and diagnostic results supporting impairment. Organize your review accordingly: identify the conclusion, then locate the evidence offered for it.
If a spine rating relies on a neurological finding, identify where the examination documents it and how the diagnostic evidence was considered. Flag conflicting measurements or inconsistent imaging descriptions, but do not supply your own medical interpretation. A difference between an earlier therapy measurement and the IME measurement warrants explanation; it does not, by itself, establish that either measurement is wrong.
Trace the Rating From Clinical Findings to Percentage
Identify Each Input and Intermediate Step
Record the Clinical Inputs and Selected Method
Review the calculation as a traceable sequence rather than a single result. Your worksheet should identify the following items where the governing method uses them:
- The condition and anatomical region being rated.
- The clinical findings selected as rating inputs.
- The cited method, chapter, and table.
- The starting value or classification and its stated basis.
Follow Adjustments Through the Final Result
- Any adjustments, conversions, or combination steps.
- The rounding method and final labeled percentage.
If the report moves directly from a diagnosis to a percentage, ask the examiner to supply the intermediate reasoning. Do not select a different clinical category yourself simply because another table appears potentially relevant.
Distinguish Regional Impairment, Whole-Person Impairment, and Disability
Every percentage should identify what it measures. An upper-extremity impairment percentage should not be compared with a whole-person impairment percentage as though they were equivalent. Neither label should be replaced with “disability” without identifying the applicable basis.
Account for Jurisdiction-Specific Disability Determinations
California: Identify the Medical Input and Subsequent Calculation
The California Division of Workers’ Compensation explains that its permanent disability formula uses medical impairment, age, and occupation, with the formula depending on injury date (DWC – I was injured at work – Permanent disability benefits). Identify whether the report provides the medical input or also presents a subsequent disability calculation.
Review whether the impairment-rating framework complies with the applicable state and jurisdictional requirements. Consult the DWC FAQs on the PDRS for practitioners when checking the procedure for the claim before importing a calculation from another file.
Apply the 1.4 Adjustment Only Under the Applicable Procedure
In its discussion of the applicable SB 863 procedure, California DWC describes multiplying whole-person impairment by 1.4, rounding to the nearest whole number, and then adjusting for occupation and age (DWC FAQs on the PDRS for practitioners). Do not apply that sequence to every California evaluation or treat the intermediate adjusted value as the completed disability determination.
When reviewing a worksheet, identify where the medical rating ends and the subsequent adjustments begin. An unexplained percentage in a summary should prompt a request for the underlying sequence, not an assumption that every required step has occurred.
New York: Separate Impairment From Loss of Wage-Earning Capacity
The New York WCB states that impairment alone does not equate to loss of wage-earning capacity (Subject Number 046-472). Identify what the medical report establishes and what remains for the applicable broader determination.
Also check which guideline provisions govern the injury being assessed. The WCB overview explains that revised schedule-loss-of-use guidelines superseded specified portions of the 2012 guidelines. A general reference to “New York guidelines” may therefore require clarification. Ask for the applicable provisions rather than assuming that every portion of a cited guideline remains controlling.
Turn Review Findings Into Focused Clarification Questions
Ask About the Framework and Calculation
Questions for the Examiner
Request the missing explanation rather than framing every discrepancy as examiner error. Useful questions include:
- Which edition and version did you use, and which provisions support the selected method?
- Where does the report show the starting value and intermediate calculations?
- What does each percentage measure?
- Which adjustments or conversions were applied, and in what order?
Keep framework applicability and method execution distinct. An examiner may explain a calculation fully while counsel still needs to determine whether that framework governs the claim.
Target Medical Uncertainty and Preserve the Response
Direct medical questions to the supporting findings: What supports permanence? How was conflicting evidence considered? Could a missing record affect the opinion? What supports the stated capabilities or restrictions? A focused request might ask the examiner to reconcile a documented strength finding with a lifting restriction, citing both report pages. That is more useful than asking generally to “justify the rating.”
Use worksheet fields for report location, issue, supporting record, requested clarification, response, and remaining uncertainty. Separate clerical discrepancies from questions affecting clinical reasoning or the meaning of the result.
When preparing for using IME findings in court, preserve the distinction between the original opinion and any later clarification. Check the applicable procedures before seeking supplemental opinions or examiner testimony.
Conclusion
A useful attorney review connects the governing standard, documented findings, calculation, and jurisdiction-specific meaning of the percentage. Do not accept or reject a rating solely because its final number appears favorable or unfavorable. Identify the precise uncertainty and seek the explanation needed to evaluate it.
The resulting review should show what the examiner concluded, how the examiner reached that conclusion, and which questions remain unresolved. That distinction gives your legal team a clearer basis for assessing the report without substituting counsel’s judgment for a medical opinion.
Frequently Asked Questions
Can an injured worker obtain a copy of the medical report?
California DWC states that an injured worker has a right to receive the doctor’s report and request copies of medical reports (DWC – I was injured at work – Permanent disability benefits). Do not extend that statement to every jurisdiction or claim type without checking the applicable rules.
Does a difference between two ratings prove that one is wrong?
No. Compare their scope, reviewed records, examination dates, frameworks, rating units, and reasoning before drawing a conclusion. The difference alone does not identify its cause.
Does missing information automatically invalidate an IME report?
Not automatically. Its procedural or evidentiary significance depends on the applicable rules and case circumstances. Determine whether clarification or additional records are needed before deciding how to address the report.
How should a legal team prioritize review when a deadline is approaching?
Begin with the decision you need to make and the report passages relevant to it. Prepare a short list of unresolved questions, identify the person responsible for each follow-up, and note your working deadline. Separate missing medical explanations from clerical corrections, and verify any procedural deadlines against the applicable rules.
What should accompany a rating summary sent to another member of the legal team?
Provide the report date, examiner identity, relevant page references, and a clear statement of the summary’s purpose. Attach or identify the source report so the recipient can review the opinion in context. Distinguish direct quotations from your paraphrase, and label open questions as questions rather than findings. For a handoff between counsel, include the current review status, who is responsible for pending follow-up, and when the next decision is expected. Avoid circulating a percentage detached from its report or reproducing an earlier internal summary without checking it against the source. This keeps the handoff focused on what the recipient needs to evaluate and act on.
Offsite Resources For You
- DWC FAQs on the PDRS for practitioners — California DWC answers practitioner questions about choosing and applying the correct Permanent Disability Rating Schedule, including impairment combinations and SB 863 changes.
- Subject Number 046-472 — The New York Workers’ Compensation Board announcement explains the 2012 permanency guidelines, including MMI, impairment, functional loss, and loss of wage-earning capacity.
- Guidelines for Determining Permanent Impairment and Loss of Wage Earning Capacity Overview — This New York WCB overview identifies the impairment-guideline framework, effective dates, superseded provisions, forms, and links to the applicable guidelines.
- AMA Guides Sixth 2025: Current medicine for permanent impairment ratings — The AMA summarizes the Sixth Edition 2025 updates and reminds evaluators to confirm the state or jurisdictional requirements governing which AMA Guides version applies.
- Impairment Rating and Disability Determination: Overview — This Medscape reference reviews the distinction between medical impairment and disability and provides background on impairment-rating and disability-determination concepts.
- Maximize Reimbursement for IMEs — This 1999 AAPC article discusses the components and billing considerations of independent medical evaluations and is useful here as a historical completeness checklist rather than a current legal standard.
- DWC – I was injured at work – Permanent disability benefits — California DWC explains how permanent disability benefits use medical impairment together with factors such as injury date, age, and occupation, and notes an injured worker’s right to receive medical reports.
- Impairment evaluation in pain management: physician, or attorney in white coat? — This PubMed-indexed review examines the medical-legal interface in impairment and disability evaluations, including causation, maximum medical improvement, and impairment ratings.
- The Definitive Guide to IME vs Peer Review — MLP IME explains the practical differences between an in-person independent medical examination and a records-based peer review, including when each is most useful in legal and insurance matters.
What's Next?
Prepare for your next evaluation with MLP IME’s pre-IME preparation guidance, focusing on the rating questions, relevant records, and medical issues you need addressed. To discuss your evaluation needs, contact MLP IME or call 833-465-7463.
