The Insurance Medical Examination (IME/CR 35 Exam): What to Expect
At some point in an injury claim, you may be asked to attend a medical examination arranged by an insurance company or by opposing counsel — commonly called an “IME.” The name can be a little misleading, since the examiner is chosen and paid by the other side rather than by you. Knowing what kind of examination you are dealing with, and what your rights are, takes much of the anxiety out of the process.
Disclaimer: This post is intended for general informational purposes only and does not constitute legal advice. For guidance specific to your situation, please consult with a qualified personal injury attorney.
Two Different Kinds of Exams
It helps to distinguish two situations that often get called the same thing. The first is an examination requested under an insurance policy — for example, when your own PIP insurer asks you to attend an exam as part of reviewing benefits. The second is a litigation examination in a lawsuit, governed in Washington by Civil Rule 35 (CR 35). These two branches do not share the same requirements, and the rules that apply to one do not apply to the other.
The PIP Policy Examination
When your own PIP insurer arranges an examination or medical review, Washington regulation (WAC 284-30-395) frames the questions the insurer may raise about your medical benefits: whether the treatment is related to the collision, whether it is medically necessary, whether the charges are reasonable, and questions of timing and the available policy limits.
If a PIP insurer relies on an examination or review to limit or terminate benefits, a few protections apply. You are entitled to a meaningful written explanation of the basis for the decision, not a bare conclusion. And a review or examination used to deny or limit benefits should generally be performed by a provider in the same or a similar specialty as the provider whose treatment is being questioned. Insurers may rely on such reviews, but the basis should be examined carefully, and you have a right to understand it.
The CR 35 Litigation Examination
A CR 35 exam is different. Absent an agreement between the parties, it is not something the other side can simply demand: the party seeking it generally must file a motion, show good cause, and obtain a court order. The scope of the exam is set by that order or by the parties’ agreement, and the order identifies the examiner and the conditions — the time, place, and scope of the examination. There are real procedural guardrails around a litigation exam.
Washington also provides meaningful protections for the person being examined. Generally, you may have a representative present during the examination. And in most circumstances you may make an audio recording of the exam, unless a court orders otherwise. Video recording is treated differently — it typically requires either the parties’ agreement or a court order. An accurate record of what happened can matter if the examiner’s report later characterizes the visit differently than you remember it. If an exam is scheduled, talk with your attorney in advance about a representative and recording.
What the Examiner Is There to Do
An insurance or defense examiner is retained to form an opinion, and that opinion may not match your treating providers’ views. The examiner may reach conclusions about the cause of your symptoms, the reasonableness or necessity of your care, or whether you have reached maximum improvement. Understanding this helps you approach the exam calmly: it is not a treatment visit, and the examiner is not your doctor.
How to Prepare and Conduct Yourself
The best preparation is honesty and consistency. Report your symptoms accurately — neither minimizing nor exaggerating — and describe your limitations as they actually are, on a normal day. You are not expected to perform movements that cause significant pain, and you can say so.
When your own providers have documented not just that a test was positive but how it was positive, and have tracked your findings consistently over time, the overall record speaks for itself. Your part is to be truthful and steady; the examination is one input among many, not the final word on your claim.
After the Exam
If an examiner’s report is used to reduce or deny benefits, that is not the end of the road. A disagreement by a hired examiner does not automatically override your treating providers’ opinions. In the PIP context, the stated basis can be examined against the written explanation the insurer must provide; in litigation, the examiner’s opinion is evidence to be weighed like any other.
Above all, do not let an exam derail your care. Follow the treatment plan you and your healthcare providers believe is medically appropriate, and don’t stop necessary care solely because of an unexplained insurance letter or examination report; promptly discuss any payment issue with your provider and your attorney.
Final Thoughts
An insurance or CR 35 examination is a normal part of many injury claims, not a crisis. Know which kind of exam you are facing, understand your rights to a representative and to audio-record a litigation exam, be honest and consistent, and lean on a well-documented treatment record.
If you have been scheduled for an insurance or defense medical examination, reach out to our team before you go. We help injured people throughout Washington prepare for these exams and protect their claims.
