Personal Injury
Your doctor recommends surgery. After months of working through the pain, pushing through long shifts, and hoping that things would eventually improve, the recommendation is finally on the table: you need an operation.
Then the insurance company sends you to their doctor. And their doctor says you’re fine.
This is one of the most disorienting moments an injured worker can face in a Maryland workers’ compensation case. The insurer’s physician — conducting what is known as an independent medical evaluation, or IME — reaches a different conclusion from your treating doctor. They may say you’ve reached maximum medical improvement, that your condition predates the work injury, or that the recommended treatment isn’t medically necessary.
The IME process itself is a recognized and legally permitted part of workers’ compensation. Insurers have a legitimate interest in obtaining a second medical opinion. But the structural reality of how these evaluations work — and the frequency with which they conflict with treating physicians’ recommendations — is something every injured worker deserves to understand before they walk into that exam room.
An independent medical evaluation is an examination conducted by a physician who is not your treating doctor. In the workers’ compensation context, it is typically arranged by the insurance carrier. The insurer selects the physician, schedules the appointment, and receives the resulting report. The purpose, in theory, is to provide an objective second opinion on the nature of the injury, the need for treatment, and the claimant’s level of recovery.
In practice, the dynamic is more complicated. IME physicians are compensated by the carrier for their evaluations, and many of them conduct a significant volume of such exams on a recurring basis. That doesn’t mean every IME doctor is acting in bad faith — many are experienced physicians who take their role seriously. But it does mean there is an inherent structural tension that claimants should be aware of.
Your treating physician, by contrast, has an ongoing relationship with you. They have reviewed your history, followed your recovery over time, ordered diagnostic tests, and made recommendations based on what they observe across multiple appointments. The IME doctor will typically see you once — and often for a relatively brief examination.
That difference in perspective matters enormously when the two opinions diverge.
In my experience, treatment authorization tends to proceed without much friction in the early stages of a workers’ compensation claim. Initial medical visits, basic imaging, conservative treatment — these are rarely contested. The tension tends to emerge when the costs and complexity of the recommended care begin to increase.
Surgical recommendations are the most common trigger. When a treating physician concludes that surgery is necessary — or that a follow-up procedure is needed to address complications from an earlier one — it is not unusual for the insurer to request an IME before authorizing. The IME physician then reviews the case and may reach a different conclusion: that the claimant has reached maximum medical improvement, that the surgery is not medically necessary, or that the condition stems from something other than the work injury.
Follow-up diagnostics can also become a source of dispute. Authorization for imaging of body parts not explicitly listed on the original claim is sometimes denied, even when the treating physician’s clinical reasoning for ordering it is sound.
A scenario I have seen more than once: a claimant with a shoulder or hand injury develops persistent pain and numbness, and the treating physician suspects the source may actually be originating in the cervical spine. A neck MRI is recommended. The insurer declines to authorize it on the basis that the claim covers the shoulder, not the neck. The claimant is left without a complete diagnosis, and the underlying issue goes unaddressed.
The pattern that tends to emerge — and this is something I see consistently in my practice — is that the more significant the recommended treatment, the more likely it is to be questioned.
There are some practical realities about the IME process that claimants are rarely told about in advance, and I think it’s important to be straightforward about them.
The examination is often brief. Unlike an appointment with your treating physician, the IME is not designed as an ongoing clinical encounter. The physician reviews the records provided, conducts a focused examination, and prepares a report. Some IME doctors are thorough and spend meaningful time with the claimant. Others move more quickly. Either way, it is a fundamentally different kind of interaction than the longitudinal care your treating doctor provides.
It is also worth knowing that observations may begin before you enter the exam room. In some IME offices, staff note how a claimant arrives, how they move in the waiting area, and what they appear to be doing before the formal examination begins. These observations can appear in the final report.
When it comes to denying or limiting treatment, the two most common conclusions in IME reports are:
These are legitimate medical arguments, and they deserve to be taken seriously. The problem arises when they are applied in a way that consistently cuts against the claimant’s treating physician’s well-documented recommendations. That is when having an attorney in your corner becomes critical.
I want to share an anonymized case that illustrates what this conflict looks like in practice — and what it takes to resolve it.
My client had been injured at work in a physically demanding role — one that required standing for extended periods and regularly lifting and carrying varying loads. Despite the injury, she returned to full-time work. She pushed through the pain for months, determined to hold onto her job and her livelihood.
Eventually, she reached a point where she simply could not continue at the same pace. Her treating surgeon, who had initially discharged her from active treatment after her return to work, re-evaluated her condition and ultimately recommended surgery. The injury had progressed beyond what conservative management could address.
The insurer’s IME physician had examined her around the time of her return to work and concluded that she had reached maximum medical improvement. His opinion was that surgery was not warranted. Both physicians were credentialed, experienced doctors — and they had reached opposite conclusions.
We requested a hearing before the Maryland Workers’ Compensation Commission on the issue of surgical authorization. This is precisely the forum where the battle of the experts plays out: two conflicting medical opinions, and the Commission tasked with determining which is more persuasive given the full record.
My client testified. She described those months in honest, plain terms — what it had been like to go to work every day knowing she was pushing through real pain, the toll it had taken, and the point at which she could no longer manage. Her testimony was sincere, composed, and credible.
The Commission authorized the surgery.
What I want to emphasize about that outcome is that it did not happen by accident. Preparing a client to testify thoughtfully — helping her anticipate the questions that would be asked, understanding where the pressure points in the case were, and making sure her story was told completely and in a way that aligned with the medical record — that is the work. Without that preparation, a well-written IME report can carry significant weight simply by virtue of being there.
Of everything I explain to new clients, this is often the point that surprises them most. The IME physician is not there in a treating capacity. They are not evaluating you in order to help you get better. Their role is to provide an independent opinion to the party that retained them — which is the insurance carrier.
This is not an accusation against IME physicians as professionals. Many of them are highly qualified and genuinely try to be thorough and fair. But the structural reality is that they were selected and retained by the insurer, they are compensated by the insurer, and their report goes to the insurer. That context is relevant to how you approach the evaluation.
Claimants who go into an IME without understanding this — particularly those who are navigating their claim without legal representation — sometimes approach the appointment the same way they would a visit with their own doctor: openly, candidly, and with the assumption that the physician is trying to help them. That can lead to misunderstandings about what the evaluation is meant to accomplish and how the resulting report will be used.
Being aware of this distinction allows you to approach the appointment calmly and honestly, while also understanding what is actually happening.
One of the most consequential mistakes an injured worker can make is allowing significant time to pass without acting on a medical recommendation.
If your treating physician has recommended surgery or additional treatment and months go by without a hearing being requested or authorization pursued, the Maryland Workers’ Compensation Commission may draw an inference from that gap. The longer the delay, the harder it can become to demonstrate the urgency and medical necessity of the recommended care — because delay itself tends to be read as inconsistent with genuine need.
The causal connection between the work injury and the need for treatment also becomes more difficult to establish over time. New conditions can develop. The medical picture becomes more complex. The IME physician, if re-evaluated, now has additional room to introduce alternative explanations for the claimant’s current condition.
This is one of the clearest reasons I advise injured workers not to wait until the claim feels like it’s in crisis before reaching out for legal help. By the time the insurer is actively contesting treatment, the record already reflects whatever happened — or didn’t happen — in the months before.
If your treatment has been denied or delayed, or if you’re facing an upcoming IME and aren’t sure what to expect, feel free to reach out to me at SG Legal Group. I’m happy to talk through where things stand and what your options are.
When a claimant’s recommended medical treatment is denied on the basis of an IME report, the path forward involves filing a request for a hearing before the Maryland Workers’ Compensation Commission on the issue of medical authorization. This is a formal proceeding, and it is where the competing expert opinions are evaluated in full.
At the hearing, both the treating physician’s records and the IME report are part of the record. The attorney’s job is to present the treating physician’s case as clearly and persuasively as possible — not simply by appealing to the claimant’s circumstances, but by working through the medical records themselves.
This is something I focus on carefully in every hearing. The Commission is looking for evidence — documented clinical findings, a clear causal narrative, and a well-reasoned treatment rationale. A good attorney knows which portions of the medical record address those questions directly, knows how to frame the treating physician’s reasoning in a way that speaks to what the Commission needs to see, and can address the IME physician’s conclusions point by point.
The claimant’s own testimony is also a meaningful part of the record. A client who can describe, in their own words and with genuine detail, how the injury has affected their daily life and capacity to work — that testimony provides context that medical records alone cannot fully convey. Preparing a client to testify clearly, honestly, and without being caught off guard by the questions that will be asked is a significant part of the work.
You can find more about how I handle work-related injury claims in Maryland on our services page. If you’re earlier in the process and want to understand the foundational steps after a workplace injury, this article walks through what to do and when.
To Be or Not to Be — The Question No Injured Worker Should Face Alone
Whether you receive the medical treatment your doctor recommends often comes down to something deceptively simple: whether there is someone advocating for that recommendation as effectively as the other side is questioning it.
The workers’ compensation system in Maryland provides a process for resolving these disagreements, and that process can work in a claimant’s favor — but it requires active, timely engagement. Insurance carriers have experienced adjusters, defense counsel, and medical consultants working on their side. An unrepresented claimant facing a treatment denial is navigating that system alone.
Early representation gives you the best chance of building a strong record, responding to an IME report effectively, and ensuring that the hearing — if it comes to one — reflects the full strength of your case.
If you are dealing with a treatment denial, facing an IME, or simply uncertain about where your workers’ compensation claim stands, I encourage you to get in touch. Every situation is different, and I’m happy to talk through yours.
Disclaimer: The information provided in this article is for general informational purposes only and does not constitute legal advice. Laws and regulations are subject to change, and individual circumstances vary. For advice specific to your situation, please consult with a qualified attorney.
Ioana David, Esq.
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