# How to Write an IME Report: The Standard Structure > How to write a defensible IME report: structure, records review, answering referral questions, causation, bias and QA, grounded in published standards. Canonical page: https://medrecords.ai/content-hub/guides/ime-report-writing/ --- [Content Hub](https://medrecords.ai/content-hub/) › Guides ## How to Write an IME Report A defensible IME report answers every referral question, discloses the records reviewed, documents history and examination findings, states causation and apportionment reasoning, and is signed — following a consistent structure courts and claims teams can audit. 9 sections·5 sources·Verified 2026-08-15 ✓ 01 ### 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. 02 ### The standard structure The standard skeleton — 8 parts, in order 01 Introduction and purpose Why the examination was requested, and by whom. 02 Identity Claimant, claim number, employer, date of injury, date of birth. 03 Records reviewed Every document, listed. SEAK and WorkSafe both require explicit disclosure. 04 History Mechanism, prior treatment, work and medical history, current status. 05 Examination Positive and negative findings; a mental-state exam in psychiatry. 06 Investigations Reviewed or ordered. 07 Answers to each referral question State the question, then answer only that question. 08 Conclusions, limitations, signature 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. 1. Introduction and purpose of the exam 2. Identity: claimant, claim number, employer, date of injury, DOB 3. **Records reviewed** — every document, listed (SEAK and WorkSafe both require explicit disclosure) 4. History: mechanism, prior treatment, work and medical history, current status 5. Examination: positive and negative findings; mental-state exam for psychiatry 6. Investigations reviewed or ordered 7. Answers to each referral question — state the question, then answer only that question 8. Conclusions, limitations, signature 03 ### 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. 04 ### 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. 05 ### 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. 06 ### 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. 07 ### 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. 08 ### 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) 09 ### 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. ### Sources - [WorkSafe Victoria Guide for IME reports](https://www.worksafe.vic.gov.au/guide-independent-medical-examination-reports) - [WA Medical Examiners' Handbook](https://www.selfinsured.wa.gov/forms-publications/F252-001-000.pdf) - [SEAK IME report writing checklist](https://seak.com/ime-report-writing-checklist/) - [SEAK: How to write an IME report](https://seak.com/blog/independent-medical-exams/how-to-write-an-ime-report/) - [AMA Causation Guides (2nd ed.)](https://catalog.lib.uchicago.edu/vufind/Record/11203219) Medrecords AI Every line cited back to its page. Send one real record set. We return a cited chronology you can check line by line, and a human decides what it means. [Test on a file](https://medrecords.ai/test-a-file/?src=content-hub-ime-report-writing) [Book a demo](https://medrecords.ai/demo/?src=content-hub-ime-report-writing) ### How Medrecords AI does this work Medrecords AI does this category of work as software. The record is sorted, deduplicated and read in minutes, every statement cited back to its page, and a qualified human signs off on what it means. [Solution — **IME & medical-legal** — Referral packets prepped and cited before the physician opens them. Read more →](https://medrecords.ai/solutions/ime/?src=content-hub-ime-report-writing) [Product — **IME report drafting** — Dictation and record turned into a template-complete draft for the examiner. Read more →](https://medrecords.ai/product/ime-report-drafting/?src=content-hub-ime-report-writing) [Product — **Medical chronology** — A dated, deduplicated timeline with a citation on every entry. Read more →](https://medrecords.ai/product/chronology/?src=content-hub-ime-report-writing) Test it on a file you already have. Send one real record set. You get back a cited chronology and decide for yourself whether the read holds up — no obligation either way. [Test a file](https://medrecords.ai/test-a-file/?src=content-hub-ime-report-writing) [Book a demo](https://medrecords.ai/demo/?src=content-hub-ime-report-writing) ### Explore the Content Hub [ #### Software & platforms AI and case-management platforms across medical-record review. ](https://medrecords.ai/content-hub/software/) [ #### Service providers & BPOs IME, peer review, retrieval, and BPO providers. ](https://medrecords.ai/content-hub/services/) [ #### State programs Rules, AMA Guides edition, and MMI standards by state. ](https://medrecords.ai/content-hub/states/) [ #### Comparisons Head-to-head vendor and program comparisons. ](https://medrecords.ai/content-hub/compare/) [ #### Guides Editorial reference on report writing, MMI, and validity testing. ](https://medrecords.ai/content-hub/guides/) [ #### Conferences & events Workers' comp, claims, and IME conferences with editorial takes. ](https://medrecords.ai/content-hub/events/) [ #### Directories Link-out rosters of examiners, LNCs, and expert witnesses. ](https://medrecords.ai/content-hub/directory/) [ #### State matrix report All 10 verified state programs, side by side. ](https://medrecords.ai/content-hub/reports/ime-state-matrix-2026/) [ #### Content Hub home The full index of everything in the hub. ](https://medrecords.ai/content-hub/) Medrecords AI ### Minutes per file. Every line cited. 10¢ a page. Bring the hardest file from this page. Get a cited chronology and a report draft in minutes — every line traced to its source page, ready for your review and signature. - Minutes per file, not days - Every line cited to its source page - Flat 10¢/page, duplicates free — no license, no minimums - HIPAA-eligible · SOC 2 audit-ready [Test on a file](https://medrecords.ai/test-a-file/?src=content-hub-ime-report-writing) [Book a demo](https://medrecords.ai/demo/) See how Medrecords AI compares with anything on this page — over a 30-minute call, side by side. Last verified: 2026-08-15