It’s a critical question for insurance adjusters and employers alike, especially when a claim involves chronic pain, degenerative conditions, or delayed symptom onset.
In the world of workplace injury claims, few questions are as common - or as complicated - as this:
“Is the worker’s condition caused by their job, or is it the result of something else?”
It’s a critical question for insurance adjusters and employers alike, especially when a claim involves chronic pain, degenerative conditions, or delayed symptom onset. Sorting through medical history, timelines, and symptom progression isn’t always straightforward - and that’s exactly where Independent Medical Examinations (IMEs) come in.
When a worker reports pain or impairment, it’s not always immediately clear if the issue is:
The legal and financial implications of this determination are significant. But without objective medical insight, decisions are left open to interpretation - or worse, assumption.
An IME provides an impartial, third-party medical opinion on the nature and cause of an injury or illness. Conducted by a qualified specialist with no treating relationship to the patient, the IME offers clarity where standard documentation may fall short.
At SOMA, our panel of assessors includes orthopaedic surgeons, physiatrists, neurologists, psychologists, psychiatrists and occupational medicine specialists - professionals who are trained to:
When assessing whether an injury is work-related or pre-existing, IME assessors focus on several key factors:
Does the reported incident align with the diagnosed condition? Is the timeline of symptom development consistent with what is medically expected?
Are there signs of prior injury, degeneration, or chronic disease (e.g., arthritis, disc pathology) that would explain the current symptoms?
Was the employee functioning normally before the reported injury? Have they had limitations in this area before?
What do imaging studies, past medical records, and treatment notes show? Is there documentation of prior complaints or related conditions?
Was the pre-existing condition permanently worsened (aggravation) or temporarily flared up (exacerbation)? This distinction often impacts claim validity and entitlements.
IMEs are not about denying claims - they’re about understanding them.
When a claim is unclear or contested, an IME can:
At SOMA, our medical team understands both the clinical and administrative needs behind every referral. We work with case managers, insurance carriers, and employers to deliver reports that are thorough, objective, and easy to interpret.
In complex or borderline cases, don’t rely on guesswork. An IME is one of the most effective tools available to clarify causation, ensure fair decisions, and maintain the integrity of the claims process.
If you're reviewing a case and wondering “Is this really a workplace injury?” - it may be time to book an IME.
Contact SOMA Medical to speak with our team or make a referral today.