Significant professional and legal difficulties and risks may be associated with the performance of impairment evaluations, particularly in the context of an independent medical evaluation (IME). Many IMEs occur in legal arenas and may involve individuals with challenging personalities, and the circumstances of performing an IME are unique because there exists no physician-patient relationship. The best defense against professional or legal difficulties is prevention, including establishing a well-thought-out process for performing these evaluations, being consistent with directives provided in the AMA Guides to the Evaluation of Permanent Impairment, and, if a problem arises, dealing with it directly and documenting the circumstances. If an examinee is uncooperative, the examining physician may need to explain his or her role, and, if the examinee remains uncooperative or is disruptive, the examiner may stop the examination, notify the client, contact the police as appropriate, and document what occurred. Injury claims against an examiner may be forestalled by preventive strategies such as obtaining written informed consent from the patient to perform the evaluation, having a member of the examiner's staff present during the evaluation, and, after the examination, using a patient satisfaction survey to document “no difficulties with the evaluation.” IMEs require examiners to be familiar with legal aspects of confidentiality, libel and slander, negligence, and other issues. Examiners should ensure their medical malpractice insurance is suitable for this work.