From across the room, Dr. Wendelin Schaefer squinted toward Marcus Jordan as he measured the movement of his arm. Screenshots of the recorded exam show the doctor, dressed in a purple shirt and tie, leaning back in his chair as he assessed Jordan from several feet away.
Jordan stood shirtless as he watched the seated physician extend the goniometer, a tool used to gauge a joint’s range of motion, out into the space between them.
“He got up, like, twice,” Jordan said. “It’s my understanding you aren’t supposed to just sit in the chair and just eyeball measurements.”
Independent Medical Exams — assessments done by a third-party doctor to evaluate an injured worker’s symptoms and recovery — carry significant weight in the state Department of Labor & Industries system for workers’ compensation. They are also considered controversial.
Opinions from IME doctors can lead to the pausing of treatment or wage-replacement payments. They also determine the size of a worker’s settlement once an injury has reached its maximum medical improvement. Between 2020 and 2024, the state’s workers’ compensation system spent roughly $100 million on these exams.
Injured workers and their lawyers find IMEs problematic, alleging they often favor L&I or self-insured employers — the entities paying for the exams — while holding a disproportionate amount of power over claims. This year, workers have filed dozens of complaints against doctors over these exams this year. Some said the doctor’s report did not match what took place during the exam or contradict their attending provider’s opinion. A recent state law may start to shift this dynamic.
Labor & Industries, which manages the state-funded workers’ compensation and oversees self-insured companies, contends the exams offer injured workers a second opinion on treatment and recovery progress. L&I data indicates that most exams are done to assign an impairment rating, something many attending providers refuse to do. IME doctors who spoke with Cascade PBS said that finding causation for injuries is very difficult, especially in complex cases that contain hundreds of pages of medical records.
In Jordan’s case, the doctor’s report from his February 2025 exam determined he could return to work as a safety manager. The doctor concluded that Jordan’s current symptoms were not caused by the car crash he suffered while on the job.
“If an employer requested it and L&I pays for it, then that physician is going to write in favor of those two parties,” Jordan said in an interview. “You’re hiring that person to write exactly what you want to hear.”
‘Defense medical exams’
L&I claim managers schedule IMEs for a variety of reasons — most commonly to close a claim and determine a disability rating, evaluate a workers’ recovery or add a new diagnosis. The exams do not provide any medical care to support the goal of healing injuries so a worker can return to the job.
Over the past five years, L&I spent between $16 million and $25 million a year on IMEs — part of the roughly $605 million the agency pays out each year in medical and vocational retraining benefits.
Roughly 10% of the state-funded workers’ compensation claims involve at least one IME, according to a 2023 L&I report. About three-fourths of Washington employers participate in the state-run workers’ compensation system managed by L&I.
The remaining companies are self-insured. Mandatory reporting of medical costs for these employers, including IMEs, started in 2020. L&I says it has a limited ability to compare IME data between the state and self-insured systems because it depends on self-insured employers to report their own costs.
An employer, who has access to their employees’ workplace injury medical records, can request an IME on its worker’s claim. For the state fund, it’s ultimately up to L&I claims managers to decide whether to schedule an IME or not.
Like many other lawyers who specialize in workers’ compensation, Mackenzie Sanders refers to IMEs as “defense medical exams.” Sanders said the exams are not inherently good or bad, but rather the problem is the degree they are used.
“They’re using them to basically fight against treating providers who are just trying to practice medicine,” Sanders said. “It’s so common for them to really tamper down what’s actually happening, or putting on something else.”
“It’s always age-related,” she added. “It’s always weight-related. … It’s always something else.”
Brenda Heilman, assistant director for Insurance Services at L&I, said the exams give L&I the information needed to make decisions about benefits for workers.
“It’s a common kind of misperception that IMEs are to deny a claim, and that is not true,” Heilman said. “IMEs are useful in our system.”
Heilman said L&I first contacts an injured worker’s attending provider when scheduling an IME, but those physicians often decline.
“I think they just want to treat people and not necessarily do kind of administrative closing reports,” Heilman said. “I don’t have an exact answer, but that’s the sense that I get.”
If an injured worker refuses to attend an IME, state law directs medical and any wage-replacement payments to be cut off. Self-insurance companies are often the worst offenders of using IMEs to drag out claims, according to the dozens of lawyers and injured workers interviewed by Cascade PBS.
A recent Cascade PBS investigation found the broader workers’ compensation system can ensnare workers in a cycle of appeals that drags out claims and delays treatment.
Lizz Giordano
Diana Kraemer, member and former president of the International Academy of Independent Medical Evaluators, said IMEs ultimately give workers better care because it provides them with a second opinion.
She said she does about 100 IMEs a year, mostly for self-insured employers. In complex cases, Kraemer said determining causation of injury is very difficult, and agrees that who is retaining and paying the doctor will influence how they think.
“Plaintiff’s attorneys are biased. … They’re supposed to be biased. That’s their job. They’re supposed to be advocates for their person,” Kraemer said. “I think it is disingenuous to say that the person who retains you does not affect your approach.”
Complaints
A year after his car wreck on the job in February 2024, Marcus Jordan, a safety manager who is contesting his most recent IME with Schaefer, said his recovery had stalled out. His right elbow and wrist still throbbed during household chores.
Jordan’s attorney said he lost his wage replacement in February due to the opinion of the IME doctor and L&I closed his claim. Jordan filed a complaint two weeks after his Feb. 10 exam, asking L&I to throw out the doctor’s determinations.
Since 2020, more than two dozen complaints have been filed against Schaefer for alleged inadequate exams and factual errors, according to documents obtained in a public records request. The complaints have come from injured workers, lawyers, attending providers and at least one claims manager.
“[L&I] is failing to act on multiple complaints, and is taking the opinion of the examiner who has multiple complaints raised against [him],” Jordan’s lawyer Elizabeth LePley said. “We want the doctors to perform correct examinations due to the disproportionate weight the department affords these ‘independent’ medical examinations over the treating doctors.”
Matt Ross, a spokesperson for L&I, said patients should never have to question the quality of an IME. He confirmed the agency has opened an investigation into Schaefer. The doctor can continue to perform IMEs while the investigation remains active.
“L&I takes complaints seriously and thoroughly investigates each one,” Ross wrote in an email; “this case is a good example of one of the potential benefits for patients to be able to record their exams and use those recordings to work with L&I on improving IMEs.”
A May 2025 L&I presentation stated that less than 1% of the approximately 12,600 exams conducted in 2024 drew a complaint.
L&I declined to describe the correct way to use a goniometer, and instead recommended consulting relevant professional associations, such as the American Physical Therapy Association or American Occupational Therapy Association.
Ross noted L&I met with Schaefer and MCN, the firm that employs the doctor, in May.
“We did ask that Dr. Schaefer start standing and aligning the device to the joint when taking measurements to make sure patients feel confident in their exam, and he agreed,” Ross added.
MCN, the company that hired and scheduled Schaefer for the exam, declined to answer questions citing privacy rights.
Schaefer, who turns 87 this year, is one of two dozen mostly retired doctors who have each charged L&I more than $1 million over the past five years for conducting IMEs. He performed 270 IMEs in 2024, down from the 306 done in 2023, billing L&I $260,660 and $277,001 respectively, according to agency data. Doctors typically keep about 50% of the fee.
Schaefer did not respond to multiple messages asking for comment.
“Our quality assurance process includes a thorough review of all complaints regarding our services and the credentialed, contracted providers with whom we work,” MCN spokesperson Barb Robinette wrote in an email.
Robinette declined to comment further, citing privacy concerns.
The company calls the exams a helpful tool “to evaluate the status of a claim and develop a strategy, timely and cost effectively.”
Recording law
During introductions for her IME, one injured worker said, the doctor tried to break the ice with a story about recently catching another person lying about their injuries. Due to ongoing appeals related to her workers’ compensation claim, Carrie asked to be identified by just her first name.
Carrie told Cascade PBS she suffered an injury to her left foot while working in a warehouse in 2017. Once an avid skier and runner, Carrie said she can no longer turn to exercise to help keep her depression and anxiety under control. Her IME in April marked her third such exam for her ongoing claim.
The IME doctor’s report determined her depression and anxiety were not related to her workplace injury, contrary to her attending provider’s opinion, but because “perhaps her fifth husband does not share her interests,” the report said, according to Carrie.
Carrie read the report aloud. “It is accepted that the claimant has symptoms of depression and anxiety,” she quoted. This is followed in the report, she said, by a bracketed statement: “[We all do.]”
Carrie said the psychiatrist’s report included factual errors about her personal history, something she also says is completely unrelated to her injury and recovery.
She said she regrets not recording the exam. A 2023 law now allows injured workers to record IMEs. Workers’ compensation lawyers lobbied for the new law because they had often heard from clients about doctors rushing thorough exams or not performing any physical testing.
“One of the most common things we were told [is that] doctors were only in the room for a few minutes, and the doctors didn’t do any testing,” workers’ compensation lawyer David Lauman said. “We would always get horror stories from our clients about these things, and doctors deny it, and it was hard to prove.”
The number of IMEs dropped about 40% between 2020 and 2024. As the new law was rolled out, some doctors have refused to allow the exams to be recorded, worried the videos could surface on social media. COVID also had an impact on the numbers, according to L&I.
Jordan’s attorney LePley said she hopes that the new law will make it easier to get rid of IME examiners who fail to meet standards. Clients have filed complaints against doctors for inadequate exams, factual errors, appearing intoxicated and racist remarks.
“Recording creates a leveling of the playing field,” she said.
