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What is an Independent Medical Examination?

by | Jan 7, 2021

Personal Injury Law (1)

An Independent Medical Examination (IME) is a tool that insurance carriers use to examine their own customers that have been injured in an accident to suspend their medical benefits or limit their medical treatment under Personal Injury Protection (PIP) insurance. Unfortunately, such examinations are obligatory, if the insurance carrier can show that the mental or physical condition of the injured party is salient to the medical benefits claim.

(Note: IMEs are not the same as Compulsory Medical Examinations, which can be requested by either party’s insurance carrier. CMEs occur after litigation has begun to defeat the lawsuit or mitigate damages.)

Moreover, rarely are these examinations “independent”: The IME is generally conducted by a physician that has been hand-picked by the insurance carrier and that they expect will report back in their favor. In our experience, we have run into IME physicians that produce the same report regardless of the individual circumstances. 

An IME physician’s report is only usable to reduce or limit your PIP benefits if the IME physician has the same licensing as your treating physician. This means that an insurance carrier cannot use a Neurologist’s examination to stop paying your Chiropractic medical bills, nor a Podiatrist’s report to avoid paying for Neurological medical treatment.

Your insurance carrier has a fundamental right to an IME. If you refuse to submit to or to attend a lawfully granted IME, you will deemed to have breached the insurance policy. Refusing could also serve to release the insurance carrier from all liability for further medical payments. (Do note, though, that failure to attend the IME is not necessarily an “unreasonable refusal” to attend. The insurance carrier has the burden of proving the failure to attend was unreasonable.)

Your Rights

You do not have to pay for the IME. The insurance company must pay for the Independent Medical Examination, and they must give you ample notice of any examination so you can make arrangements to attend.

The insurance company cannot make you travel unreasonable distances to attend the IME. They are required, unless no physician exists, to select an IME physician that is in the municipality where you are receiving treatment or in a location reasonably accessible to you (that is, within 10 miles from your residence).

When our clients undergo either an IME or CME, we prefer to record the examinations. You should tell the physician all of your injuries, and by taping the examination, we can compare and contrast what the IME physician performed with your treating physician.

Insurance Problems?

If you’ve been hurt in an accident and your insurance company is refusing to pay your benefits, let us know! Act swiftly so we can intercede on your behalf and take on your insurance company. Click the button below to learn more about how we can help you.

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Other FAQs!

Don’t miss these other FAQs from the lawyers at Personal Injury & Accident Law Center, your go-to resource for information about personal injury cases in Boca Raton. 

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