Know What Medical Exams Are Designed To Do
If the insurance company is asking you to undergo an “independent medical examination,” you should know the insurance company is often looking to find something about your current medical condition or in your medical history that they will try to rely upon to say your medical problems are not related to, or were not caused by, the car or other accident in order to underpay or deny your claim. While most insurance policies that cover personal injuries require you to submit to an independent medical examination, know that you are entitled to have an attorney present when the insurance company conducts an independent medical examination, and you have the right to have the examination recorded. If the examination is not recorded, what was done during the examination (or, more often, what was not done) will become a matter of “he said, she said,” i.e., your word against the insurance company's, and it is always better to have recorded evidence than rely on your memory. If an insurance company is asking that you undergo an independent medical examination, you should contact a personal injury lawyer, and ask whether the attorney is available to attend the examination with you and to help you record it. If you have any questions about something an insurance company is trying to make you do as part of its investigation of an insurance claim, contact us. We never charge any fee or cost to sit down with you, explain your rights as a policyholder, and tell you what you are required, or not required, to do under the policy.
3 Things to Keep in Mind About IMEs
1) In theory, IMEs are intended to flush out the extent of your medical issues so the insurance company can determine the amount of costs you are entitled to recover. Meaning, the more complicated and extensive your injuries, the more they have to pay. For this reason, the insurance companies often use IMEs to try to reduce or eliminate the scope of your injuries to limit the amount of money they have to pay on your claim. In other words, if the insurance company cannot prove the accident was your fault, they may still try to prove you are not as injured as you claim. They do this by hiring a medical professional to examine you who is trying to find medical support for a diagnosis that works against you and your personal injury claim. For example, if you tore your rotator cuff in a car accident and your primary care physician has recommended you undergo surgery to repair it, the insurance company responsible for paying your medical expenses, may ask that you undergo an "independent" medical examination by one of their hired medical professionals in the hopes their doctor will find you did not in fact tear your rotator cuff and you do not need surgery. This way the insurance company does not have to pay as much on your claim. It is important to remember these physicians are not concerned with your medical well-being and will never offer you any medical advice. Their goal is to attack your credibility and the credibility of your primary care physician. Some examiners work exclusively for insurance companies, but they are not obligated and, therefore, often will not tell you that.
2) What is the best way to ensure your IME is conducted fairly? Having both sides present and having the examination recorded. You should never have to give up your rights so an insurance company can exercise theirs. In most cases, you have the right to have your personal injury attorney present to ensure the examination is fair and accurate and to protect the integrity of the examination, i.e., both by recording it and standing witness. If the examination is not recorded and the medical professional does not conduct a thorough examination (for example, assume he does not even examine the site of your injury), you may have no way to prove later, when the doctor claims your injuries are not as extensive as you say, how poor his examination was because you did not exercise your right to have your attorney present and have the examination recorded. Your attorney can also have the examination recorded to ensure that the IME is being conducted in a manner that does not violate your rights or the rules that govern insurance companies.
3) You may not be obligated to even undergo an IME. While, generally speaking, if you are asking an insurance company to pay for an injury, the company has a right to investigate the scope and extent of your injury; however, they do not have a right to subject you to examinations of conditions you are not seeking compensation for. In some cases, these IMEs are just attempts to badger or harass victims of personal injury in order to gain advantage. The classic example of an unnecessary and harassing IME is one requesting a psychological evaluation of a physically-injured person who has no history or indication of mental disease or disorder. Do not submit to an IME of any type before speaking to a personal injury attorney.
Also, when undergoing an IME, it is important to remember to never volunteer information unless asked. Everything about you—from your clothing to your demeanor to your statements—will be documented, scrutinized, and reported to the insurance company. Having an experienced attorney to prepare you for the process will help you protect your interests. If you think you have a personal injury claim or have been requested to submit to an independent medical examination by an insurance company, and have questions about it, contact us.