OBJECTIVE: To assess outcomes for different times to the first independent medical evaluation (IME) for work-related lumbosacral sprain. METHODS: The 2005 West Virginia workers' compensation claims for "lumbosacral sprain" were used for our analyses. Outcomes included costs, maximal medical improvement status, number of IMEs performed, and the length of temporary total disability. Multiple logistic regression modeling was applied to determine the significance between the timing of first IME and these outcomes. RESULTS: Patients with a first IME within 101 to 150 days after the injury had the best outcomes, measured by no repeat IMEs, appropriately reaching maximal medical improvement, and decreasing the temporary total disability length and related costs. CONCLUSIONS: Scheduling the first IME between 101 and 150 days after the injury contained indemnity costs, and shortened the length of disability.