If you are asking this question, chances are you have been involved in some sort of accident and as a result, your insurance company can require you to visit a physician of their choice. As daunting and frustrating as this may seem, it is important to understand that this is a normal process when determining settlement of insurance claims. More often than not, your insurance company will say that you must have an Independent Medical Exam (IME) done. The IME also commonly occurs in workers' compensation claims and, in a personal injury case, if the case is in litigation [i.e. a lawsuit has been filed].
Essentially, what this means is the insurance company has hired or retained a doctor to give opinions that the insurance company believes will support their defenses or the denial of your claims. The physicians utilized by the insurance industry to conduct these exams are typically highly regarded, skilled professionals and respected by their peers. These are physicians that command esteem and their opinions will be listened to. Having said that, do not misunderstand what is behind these appointments. These physicians are being paid by the insurance company for their time in reviewing medical records and conducting a physical examination of an injured person. As result of this, the insurance company fully expects a conclusion that supports a defense or a denial of the claim. In a worst case scenario, they expect an opinion that will materially limit the injured persons claim by finding a lack of causation, connection, or disability.
Now, understand this is not sinister. Any good plaintiff’s attorney in an appropriate case is going to retain an expert that the attorney believes will support or bolster his or her client's case, and that expert is going to be paid for their time. Both sides utilize experts. Conflicting expert options, especially medical opinions, are everyday occurrences in injury based litigation.
However, there are a few points about the IME is that you should keep in mind:
- Firstly, an insurance company has a far broader range of resources than the average car accident victim or injured worker, and in turn, they will indeed use them to hire professionals who they feel will report in the insurance company’s favor.
- Another thing to understand ahead of time when going into your IME is that you, as an injured person, are most likely going to disagree with what the physician says.
Although the insurance industry may utilize an IME for any number of purposes, some of the most common purposes are:
- Causation. Here, the defense and the insurance company are seeking and paying for an opinion that an injured person’s pain complaints, symptoms, or indeed the injury itself are the result of anything under the sun other than the accident. Some common reports attribute the injured person's complaints to an underlying degenerative process or a prior injury, but not the subject injury.
- Surgery or other medical treatment is not necessary or needed. This is not unusual in the workers' compensation system. If an insurance company does not want to pay for a surgical procedure or other forms of medical treatment, they hire a doctor to opine that the treatment is not necessary, or that the surgery is not needed.
- Disability. This is also a common subject of defense IMEs in the workers' compensation context. Here, opinions rendered are typically that, although a person might be hurt, the disability is not as significant as that expressed by the treating doctor or plaintiff's IME doctor.
It certainly happens that a defense IME physician agrees with the plaintiff’s doctor and the insurance company typically has little choice but to go along with what their own doctor says. However, be mindful that this is rarely the case. Moreover, although there should be some notion that an insurance company should be bound by what their doctor says, this also is not always the case.
-This Article was updated by Eric Kirk on 3/11/19 and 7/27/20.