A Defense Medical Examination (DME) — sometimes called an Independent Medical Examination (IME) — is a medical evaluation requested by the defense in a personal injury or workers’ compensation case. Its purpose is to allow the defendant’s insurance company or legal team to have their chosen doctor examine the injured party (the plaintiff or claimant) and provide an independent assessment of their injuries, treatment, and current condition.
Although called “independent,” the doctor performing the exam is hired and paid by the defense, which is why professional oversight and accurate documentation are essential.
Purpose of the DME
The defense uses the DME to:
- Verify the extent and legitimacy of the plaintiff’s injuries.
- Determine whether injuries are consistent with the reported accident.
- Assess whether the injuries have improved or resolved.
- Provide a medical opinion that can be used in litigation or settlement negotiations.
Roles During the DME
1. The Doctor (Defense Examiner)
- The doctor is selected and paid by the defense attorney or insurance company.
- Their role is to evaluate, not treat, the examinee.
- The doctor will usually:
- Review medical records and imaging reports provided by the defense.
- Ask the client (patient) oral history questions about the incident, prior injuries, and current symptoms.
- Perform a physical examination focused on the injured body parts only, as limited by the Response to Demand.
- Generate a written report summarizing findings and medical opinions, which is sent to the defense attorney.
2. The Client (Examinee)
- The client is the injured party, usually represented by a plaintiff’s attorney.
- The client’s rights and the scope of the examination are defined in the Response to Demand, a legal document outlining what the doctor may or may not do or ask.
- The client is expected to:
- Cooperate respectfully.
- Answer questions relevant to the injury.
- Avoid discussing legal strategy, prior claims, or unrelated medical issues.
3. The Nurse Observer
- A nurse observer is a licensed registered nurse who attends the DME on behalf of the plaintiff’s attorney.
- The observer’s purpose is to protect the integrity of the examination and advocate for the client’s rights without interfering in the process.
- Responsibilities include:
- Monitoring the exam for compliance with the Response to Demand and state law.
- Ensuring the doctor stays within scope — focusing only on the approved body parts or conditions.
- Documenting all aspects of the exam: time in/out, questions asked, tests performed, and any inappropriate behavior or comments.
- Making professional objections to improper questions (for example, about prior medical history not related to the injury).
- Supporting the client emotionally and professionally to ensure comfort and fairness.
What Typically Happens During a DME
- Check-In: The nurse observer verifies the doctor, exam purpose, and the client’s identification.
- Oral History: The doctor asks limited questions about the current injury (e.g., “How did you injure your back?”), not about unrelated history or prior claims.
- Physical Examination: The doctor examines the injured area only — for instance, range of motion, strength, reflexes, or pain level.
- Documentation: The nurse observer takes detailed notes and timestamps key moments.
- Conclusion: Once complete, the doctor writes a report for the defense; the nurse observer completes an observation report for the attorney’s records.
Why the Nurse Observer’s Role Matters
- Ensures legal and ethical compliance during the exam.
- Protects the client’s rights from examiner overreach.
- Provides the attorney with accurate, professional documentation in case the doctor’s report is incomplete or biased.
In Summary
A Defense Medical Examination is a crucial and legally sensitive event in a personal injury case. It involves the defense’s doctor evaluating the plaintiff, while a nurse observer ensures fairness, accuracy, and compliance with the agreed legal terms.
DME Boot Camp trains nurses in exactly this — how to observe professionally, object appropriately, and protect clients with skill and confidence.