IME Insurance Company Abuse

As insurance companies and claims adjusters demand that vehicle accident victims drive hundreds of miles and spend several hours away to undergo required independent medical examinations, IME insurance company abuse is taking on a new form. But what makes matters worse is that these businesses insist that the car accident victims—and not the company—pay for travel charges, even though doing so would have their traveling for hours to see some very well-known insurance doctors.

An IME is a medical examination (or examinations) requested by an insurance company to assess the type and severity of your injuries after an accident.

According to your insurance contract, if you’ve filed a claim for No Fault Benefits with your own motor insurer, the firm has the authority to arrange as many medical exams as they deem necessary. Usually, the business will arrange for you to visit medical professionals who work in fields related to those of the current practitioners. For instance, the business will arrange for you to get an independent medical evaluation with a chiropractor if you are receiving treatment from one. The insurance company will refer you to an orthopedist if you have a broken bone. You are required to comply with the insurance provider by showing up to these visits. You run the danger of losing your No Fault benefits if you don’t.

The insurance provider for the party you might be suing in an accident case is similarly responsible. The insurance company has the right to seek an unbiased medical opinion as you are claiming injuries so that it can attempt to value your claim.

It’s Important to Know That IMEs are not Independent

These physicians are employed by companies that have contracts with the insurance provider. In New York, all of the various insurance carriers receive IME doctors from the vendors, who act as sort of middlemen. The conduct of IMEs is frequently the doctor’s sole source of income. Do you think that sounds independent?

Additionally, you should be aware that these doctors won’t be treating your injuries. In reality, the exact reverse is true. Since they depend on the insurance provider for a steady flow of work, they will look for opportunities to inform the insurer that you do not require more medical attention or that your injuries are not as severe as you say.

Keep These Items in Mind if you are Scheduled for an IME

  • Let your attorney know when and where your appointments are scheduled
  • Write down all of your symptoms to take with you so you don’t forget.This list should include your physical limitations and where your pain is.
  • Ladies, refrain from wearing shoes with heels. Doctors will make note of what you wear to the examination.? You do not want the doctor to make a judgment call about your condition based upon what you decided to wear on your feet.
  • Don’t exaggerate your symptoms to the doctor. You risk damaging your claim.
  • The doctor will ask you questions regarding the accident and your injuries. Be brief and to the point. No need to elaborate off topic. Again, this doctor is not treating you.
  • Take written notes of what time the examination starts and what time it ends. Note what types of tests the doctor performed on you. Give your attorney this information.
  • Do not allow the doctor to give you invasive tests such as X-Rays or EMGs.
  • Keep in mind that every move you make is being observed, including walking and getting on and off the examination table.

It is not unusual for independent medical examinations to be abused. Using hired-gun independent medical exam doctors, businesses have been misusing these so-called “independent” obligatory medical examinations with a doctor of their choosing for decades to “cut-off” No-Fault benefits. When they are chosen and engaged by the defense attorneys and corporations of the individual who caused the vehicle accident, these doctors are used by the company to terminate payment of No-Fault benefits or to use as a defense in a civil case for personal injury.

Unfortunately, the new auto No-Fault law that was passed in 2019 does very little to safeguard those who were involved in auto accidents. In fact, it may be argued that Michigan’s new vehicle No-Fault law is simply a gigantic boondoggle for independent medical exam doctors because they will mostly be in control of approving medical care under the new managed care alternative.

With the newest twist to IME insurance company abuse, however, insurers are attempting to step up their game of harassment, annoyance, and intimidation by compelling car accident victims to travel at their own expense — in many cases, literally across the state of Michigan — at the expense of their own health and well-being. This is especially true considering that many of these victims already have serious injuries that make sitting and moving around difficult.

Why? My suspicion is that claims adjusters are doing a cynical calculation that some accident victims would reject, either because to their discomfort and injuries or the associated costs. This will provide these adjusters and businesses with justification to later refuse and/or dismiss the No-Fault claims made by the affected plaintiffs. Basically, if the accident victim cannot or will not comply with a purposefully unreasonable request, they can use non-cooperation with the corporation as a justification to immediately suspend and cut-off all medical and wage loss payments and other necessary No-Fault PIP benefits.

Below I will discuss steps that car accident victims can take to protect themselves.

Read also: Car Insurance For Teenagers In Michigan

What is an independent medical examination?

A doctor chosen, employed, and compensated by your insurance provider will conduct an independent medical examination, which is a non-medical examination. The doctor’s objective is NOT to identify your illness or treat it. His or her goal is sadly but far too often just to try to find a reason to say “nothing is wrong” so your insurance company can stop paying benefits.

Do you have to go to an independent medical exam?

You must attend an IME insurance exam with a doctor chosen by your vehicle insurance carrier when instructed to do so if you have submitted a claim for No-Fault benefits based on injuries you sustained in a car accident.

The independent medical exam doctor must, however, meet the following requirements in order to be accepted under Michigan’s auto No-Fault law: (1) be a licensed physician; (2) have the same specialty as your treating physician; (3) be board-certified in the same specialty as your treating physician; and (4) have devoted the majority of their professional time in the year prior to your IME to the “active clinical practice of medicine.” (1) and (2) of MCL 500.3151.

Use the auto insurance policy to stop IME insurance company abuse

Your attorney may utilize your own auto insurance policy against your auto insurance company as a means of attempting to stop the exploitation of the IME insurance business. If the request is blatantly unreasonable, you do not have a responsibility to comply with either request if the policy does not mandate that you travel wherever the insurer instructs you to and that you pay out-of-pocket for the related expenses. Without legal counsel, I do not advise you to proceed. You still have an obligation to cooperate, and if litigation becomes required, your lawyer should do this on your behalf and provide a thorough justification for why the request is unjustified.

According to the No-Fault Act, auto insurance providers may incorporate “appropriate measures” for IME in their policies. (MCL 500.3151(1))

The majority of plans place a stringent contractual obligation on auto accident victims to go to independent medical exams done by doctors the insurer has chosen “as often as [the insurer] may reasonably require.”

However, the majority of auto insurance policies do not include IME exam clauses that permit the insurance company to demand that car accident victims travel to the location of the insurer’s choosing for the exam or that they pay for their own transportation costs to and from the independent medical examination.

Many of these new travel restrictions that the auto accident attorneys in my office are seeing would still fall short of the level that independent medical exam provisions would have to fulfill even when such provisions do exist in policies.

Use the No-Fault law to stop IME insurance company abuse

Using the No-Fault law, which allows a court to “enter an order” to “specify the time, place, manner [and] conditions” of an IME where “good cause” has been shown that the order is necessary “to protect against annoyance, embarrassment or oppression,” is another strategy for attempting to stop IME insurance company abuse. (MCL 500.3159)

It’s also crucial to keep in mind that, even though the No-Fault law permits businesses to demand that car accident victims who are requesting No-Fault benefits “submit” to an independent medical examination by a doctor employed by the insurance company (see MCL 500.3151(1)), the law does not grant insurers the authority or right to demand that victims travel a great distance to “submit” to an IME and/or to pay for that travel themselves.

Protecting against abuse

If your insurer wants you to travel hundreds of miles and pay out-of-pocket to attend the IME your insurance company is requiring you to submit to, you could use the terms of your auto insurance policy and the No-Fault law’s “annoyance, embarrassment or oppression” protections to make the following arguments:

  • Neither the auto insurance policy nor the No-Fault law requires a car accident victim to travel unreasonable distances to attend an IME ordered by the auto insurance company.
  • Neither the policy nor the No-Fault law requires a car accident victim to pay his or her own transportation costs for traveling to and from an independent medical exam ordered by the company.
  • Traveling (by car, truck, bus, van, plane) long-distance to and from the independent medical would be painful, exacerbate the victim’s injuries and interfere with the healing process.
  • Mileage and transportation costs of traveling distance to and from an independent medical exam would be prohibitive for victim.
  • The car accident victim cannot drive him or herself to the independent medical exam and has no driver.
  • The insurance company’s IME doctor could travel to where victim is for exam.
  • There are literally dozens or even hundreds of other doctors with the same qualifications and who practice the same area of medicine who practice closer to the accident victim who could also conduct the company’s desired independent medical exam.

By Admin

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