Why report structure decides the case
IME reports are read by claims examiners, attorneys, judges, and sometimes opposing examiners. A consistent structure makes the opinion auditable. WorkSafe Victoria's Guide for IME Reports and Washington's Medical Examiners' Handbook both specify the same skeleton: introduction, records reviewed, history, examination, answers, conclusions, signature.
The standard structure
Why the examination was requested, and by whom.
Claimant, claim number, employer, date of injury, date of birth.
Every document, listed. SEAK and WorkSafe both require explicit disclosure.
Mechanism, prior treatment, work and medical history, current status.
Positive and negative findings; a mental-state exam in psychiatry.
Reviewed or ordered.
State the question, then answer only that question.
The opinion, what it does not cover, and who stands behind it.
WorkSafe Victoria’s Guide for IME Reports and Washington’s Medical Examiners’ Handbook specify the same skeleton. The order is the point: a reader auditing the opinion has to be able to walk back from the answer to the record it rests on.
- Introduction and purpose of the exam
- Identity: claimant, claim number, employer, date of injury, DOB
- Records reviewed — every document, listed (SEAK and WorkSafe both require explicit disclosure)
- History: mechanism, prior treatment, work and medical history, current status
- Examination: positive and negative findings; mental-state exam for psychiatry
- Investigations reviewed or ordered
- Answers to each referral question — state the question, then answer only that question
- Conclusions, limitations, signature
The records-review foundation
The packet must be complete: deduplicated, chronologically ordered, and checked for prior injuries and care gaps. Medrecords automates this with cited chronologies so the examiner sees the full history before the claimant walks in. A report built on an incomplete record is the most common cross-examination kill.
Answering the questions
Best practice (WorkSafe): restate each question and answer it directly. If you cannot answer, say so and explain why rather than giving an unsupportable opinion. Do not add unrequested opinions unless the questions are inadequate — and if you do, flag it.
Causation and apportionment
The AMA Guides to the Evaluation of Disease and Injury Causation provides the methodology: work-relatedness, causal associations, alternative causes, and apportionment. In California, QME reports must address apportionment under LC 4663-4664; in Texas the designated doctor certifies MMI and rating on the RME.
Bias and objectivity
WorkSafe's guide names the 2 failure modes: taking the injured worker's side (sympathy, accepting history at face value) and taking the requesting agent's side (fee-for-service drift). The report must remain independent of both; bias is contractual, not just ethical.
Defending the report
SEAK's report canon (Babitsky/Mangraviti/Melhorn) covers the 25 cross-examination tactics and how to defeat them: stay in your true area of expertise, cite texts and journals accurately, keep conclusions consistent with findings, and document exactly what you reviewed.
QA checklist before sign-off
- Every question answered
- Every record reviewed listed
- Findings match conclusions
- Causation and apportionment reasoned, not asserted
- No outside-expertise opinions
- Signed and dated
- Red flags checked (symptom validity, contradictory records)
Free resources that teach this
WorkSafe Victoria's Guide for IME Reports and IME Service Standards; Washington's Medical Examiners' Handbook; SEAK's IME Report Writing Checklist; the AMA Guides and Causation treatises. Course-replacement guides based on SEAK Masters and the CA DWC QME curriculum are being built on this hub.
