Brandy Davis: A New Adjuster’s Guide to IMEs: Things We Take For Granted with Experienced Pros

Originally posted September 29, 2026 on WorkCompWire Leader Speak

By Brandy Davis, RN, CLNC, Director of Quality Solutions, Compliance, and Provider Relations, Emperion

The workers’ comp claims industry is in the middle of a generational handoff. A wave of veteran adjusters is heading into retirement, taking years of hard-earned knowledge with them. The U.S. Bureau of Labor Statistics states that one in four insurance professionals (across all lines) is over 55.¹ Similarly, federal labor projections state that roughly 50% of the current insurance workforce will retire over the next 15 years, resulting in 400,000 openings in need of candidates.²

1 in 4 insurance professionals is over 55
-U.S. Bureau of Labor Statistics

At the same time, remote work has become the norm rather than the exception. According to data from the Insurance Information Institute 69% of workers in finance and insurance sectors are either hybrid or fully work-from-home.^2,3 This means many newer adjusters could be learning the job without the informal mentoring that used to happen at the next desk over or during a debrief after a tough call. Put those two trends together, and the result is a growing population of claims professionals stepping into complex caseloads without the benefit of this informal mentoring that has historically accompanied the formal training provided to all new hires.

Independent Medical Examinations (IMEs) are a good example of exactly that gap. Ordering one is second nature to a seasoned adjuster – but for someone newer to the role, the benefits of an IME could be unclear. That distinction matters, because a well-prepared file and a strong vendor relationship can save a claim real time, money, and credibility down the line.

This piece is written with that newer adjuster in mind: a plain look at what happens once an IME is ordered, what a thorough exam involves, and what separates a quality IME partner from one that’s just filling a request. And for our industry veterans or claims leaders, you are likely mentoring someone who will benefit from your knowledge and a documented guide to share.

50% of the insurance workforce to retire in the next 15 years.
-BLS, via U.S. Chamber of Commerce

An Objective Set of Eyes
An IME physician is, by design, a stranger to the case. They’re an expert in the relevant specialty, but they have no treatment relationship with the claimant and no stake in the outcome – their only connection to the case is the exam itself. That distance is the point: it’s what allows the physician to serve two parties at once, offering the claimant an honest clinical read while giving the requesting party a report built strictly on medical evidence, not advocacy.

Before the Exam Ever Starts
The quality of an IME is often decided before the physician ever meets the claimant. A properly prepared file should include:

• The full medical record, including prior history, not just records tied to the current injury
• The accident report and claimant statements, so the physician understands the reported mechanism of injury
• A job description, especially when return-to-work or functional capacity is part of the question
• Relevant diagnostic studies, delivered alongside any baseline tests taken before the injury

That last point matters more than it might seem. A physician evaluating a hearing-loss claim needs the current test and the pre-employment baseline to make a real comparison. A respiratory case calls for pulmonary function results, not just a chart note describing symptoms. It should also be unambiguous which conditions the insurer has already accepted on the claim – if four injuries were reported but only two accepted, that distinction needs to be documented before the exam, not sorted out afterward.

What the Physician Is Actually Listening For
Once the history-taking begins, the physician isn’t just confirming what’s already on paper. They’re probing for context that shapes the whole evaluation:

• Preexisting or comorbid conditions – a prior knee injury, diabetes, or hypertension that could be driving symptoms independent of the current claim
• Medication history – with particular attention to whether prescribed medications, especially opioids, are appropriate for the diagnosis
• Psychosocial factors – since issues outside the physical injury itself can meaningfully affect recovery and return-to-work outcomes
• Reported symptoms – compared directly against what’s documented in the existing medical record to spot correlations or contradictions

Inside the Exam Room
The physical exam itself is more structured than a typical office visit. Depending on the injury, it may include:

• Observing how the claimant walks in and moves, before any formal testing even begins
• Functional tests specific to the injury, such as a heel-to-toe walk or a squat-and-rise assessment for lower back or lower extremity claims
• Palpation to assess tenderness, muscle guarding, or an unexpected pain response
• Range-of-motion measurements taken with an actual instrument, a goniometer or inclinometer, rather than an estimate rounded to a convenient number

That last detail is a quiet but important quality marker. A report that lists motion measurements in suspiciously round numbers is a signal the exam wasn’t as rigorous as it should have been.

What Separates a Real IME Partner From a Rubber Stamp
Not every IME vendor operates with the same level of discipline. When evaluating a partner, or auditing the one you already use, look for:

• True independence, where the physician is paid for the work regardless of the findings, with no incentive tied to a particular outcome
• A deep, specialty-matched provider network, vetted for board certification, active practice, and a clean sanctions history
• Trained clinical coordination, so files are organized and nothing critical is missing before the physician ever opens them
• A real quality assurance step, where the report is checked to confirm the opinion is supported by evidence and every posed question is answered
• Jurisdictional fluency, since notice requirements and evaluation guidelines shift from state to state; get this wrong and the IME can be disallowed outright
• URAC accreditation – think of it as the industry’s “good housekeeping” seal of approval, a signal that the partner’s data security, business processes, and HIPAA practices have been vetted by an outside authority, not just self-reported

69% of insurance workers are hybrid or fully remote
-Insurance Information Institute

A partner that checks all the boxes isn’t just producing paperwork – they’re producing a report that can hold up to scrutiny from a claims adjuster, a state board, or a courtroom.

Whether you are a new adjuster with new in career colleagues, or an experienced one mentoring a new team member consider passing this piece along. A five-minute read now can save a new adjuster from learning these lessons the hard way, on a live claim. And for quick future reference, we’ve distilled these fundamentals into a one-page guide you can download here (PDF).

In Part 2 of this series, we’ll shift from the mechanics of the exam to the strategy behind it – how IMEs help claims professionals spot cases that need a second look, the critical difference between impairment and disability, and how physicians identify inconsistencies without ever playing detective.

About Brandy Davis
Brandy Davis, RN, CLNC, is Director of Quality Solutions, Compliance, and Provider Relations for Emperion. A registered nurse with more than 20 years of healthcare experience, she brings extensive expertise in clinical care, quality management, peer review, compliance, and provider relations. Her clinical background includes Labor & Delivery, Post-Anesthesia Care, Pain Management, and perioperative services, followed by leadership roles coordinating physician peer review programs and quality initiatives for a large Level I Trauma Center. Since joining Emperion, she has advanced from Quality Assurance Specialist to leading the organization’s quality, compliance, and provider engagement strategies. As a subject matter expert in the disability and medical review industry, Brandy collaborates closely with medical directors, clients, providers, and operational teams to drive quality outcomes, support URAC accreditation standards, and serve as a trusted clinical resource across multiple lines of insurance.

About Emperion
Emperion is a national provider of outsourced clinical review services including Independent Medical Examination (IME), Peer Review (PR), and Independent Review Organization (IRO) solutions. The company manages a national network of approximately 25,000 providers across a broad range of medical specialties. These capabilities promote patient recovery, return to employment, and successful claim outcomes across Workers’ Compensation, Automobile, Disability, and Health benefit systems.

Notes
¹ U.S. Bureau of Labor Statistics workforce data, via industry reporting, 2025–2026
2 U.S. Bureau of Labor Statistics projections, cited by the U.S. Chamber of Commerce, 2026.
3 https://www.iii.org/fact-statistic/facts-statistics-careers-and-employment

Disclosure:
Emperion has advertised with WorkCompWire.
This is NOT a paid placement.