The primary objective in recovering your medical bills and expenses after you have suffered a personal injury as the result of something like a car accident, work-related or personal injury, or a long-term disability, is proving your medical condition. You may be thinking, “That's easy. My doctor diagnosed me.” Unfortunately, many employers and insurance companies will not accept your own primary physician's diagnosis as proof of your medical issues. Oftentimes, they will require you undergo an Independent Medical Examination (“IME”) by a claimed “impartial” medical professional to assess the extent of your physical limitations. This is done through a medical examination and an analysis of your medical records. The purpose of these exams, the insurance company will claim, is to “objectively” evaluate your medical condition without the bias of a doctor/patient relationship. However, do not forget who is paying the “independent” professional to examine you. That is the insurance company.
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.
The premier personal injury lawyers at Taylor, Warren & Weidner have years of experience dealing with car accidents, personal injuries, as well as the ins and outs of insurance companies and the great lengths they will go to to deny a personal injury victim's claim. We never charge any fee or cost to inform you of your rights when pursuing a personal injury claim. If you've been injured in a car accident, at work or on someone's else's property, give us a call today at (850) 438-4899 to see if we can help you recover.