Did Claimant who Fell have to Swallow 2nd IME for TMJ?

What Do You Think?

Under what circumstances can a Montana insurance carrier order a second IME? Does it have to first convince a court that it has good cause for doing so? A recent case involving a worker who fell and developed TMJ addresses the standard that applies.

The employee sustained a cervical strain in August 2023 after she took a tumble while working. She received workers’ compensation benefits for that injury. About 10 weeks later, she reported that she was experiencing TMJ jaw pain as a result of the accident, and sought benefits for that injury as well. 

In April 2024, an independent medical examiner, an orthoedist, found no link between the accident and TMJ. She continued to receive treatment for TMJ pain and reported that the condition was ongoing and progressive. She reportedly had two doctors ready to testify that the condition stemmed from her fall.

In August 2026, the carrier scheduled a second IME with a dental surgeon specializing in jaw conditions, including TMJ. The employee opposed the request, arguing that the carrier didn’t show it had good cause to order it. The carrier asked the court to require the claimant to attend the August IME.

In the event of a dispute concerning the cause of an injury, an insurer may require the claimant to submit to an IME by a doctor who has adequate and substantial experience in the particular field of medicine concerned. § 39-71-605, MCA.

Was carrier entitled to order a second IME?

A. Yes. A second IME was needed to help determine causation.

B. No. The carrier first needed to show that it had good cause for doing so.

If you selected A, you agreed with the court in Jordan v. XL Specialty Insurance Co., No. PI-2026-0000102-WCI (Mont. WCC 09/08/26), which ordered the employee to go to the second IME.

The statute at § 39-71-605 allows an insurer to obtain an IME without having to ask a court, show good cause, and obtain a court order. Instead, it must show that the IME is for purposes relevant to the claim and appropriate to the handling of the claim.

Here, the carrier met that standard. It showed that it needed an IME conducted by someone specializing in treating jaw conditions. The first independent examiner did not specialize in such treatment. Further, because the carrier was disputing causation, it needed another IME to find out if the TMJ was connected to the workplace fall. “The requested IME will address this issue, which is not only relevant, but central, to the claim,” the court said. 

Finally, the employee had undergone additional treatment during the two years since the original IME. This resulted in diagnoses and findings that were neither known to nor addressed by the first independent examiner.

Share This Article: