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My Insurance Company Wants me to Attend an "Independent Medical Exam," What Should I Do?

Posted by Scott Edwards | Jan 28, 2019 | 0 Comments

Swe.ime

Insurance companies have the right under almost all automobile insurance policies to verify you're your medical treatment is “reasonably and necessarily incurred as a result of” the collision. One way the insurance company can almost always this is by asking you to see a doctor of their choosing. This is called an “Independent Medical Exam” or an “IME”.

As the name suggests, an IME is supposed to be “independent”—a fair and neutral check to prevent fraud by persons trying to abuse the system. Insurance companies often hire doctors who routinely work for the insurance companies and who may be either biased toward the insurance company's bottom line or are overly conservative when it comes to determining treatment guidelines and deciding what constitutes a “reasonable” amount of time to treat for an injury. For this reason, at Schauermann Thayer we call these exams “Insurance Medical Exams”. With some exceptions, these exams are almost never “Independent.”

Unfortunately, notwithstanding the often biased nature of an IME, your insurance policy likely includes a duty to cooperate with your insurance company's investigation. This oftentimes puts crash victims in a Catch-22—attend an IME to have the doctor decide that any collision related conditions have resolved or that additional treatment is not related to the collision, or don't attend an IME and have medical bills denied for failing to cooperate with the insurance company's examination. Truly a lose-lose situation.

When our clients are ordered by their insurance companies to attend this type of exam, we typically offer them the following advice:

  1. BE AS COOPERATIVE AS YOU CAN. But remember that the doctor is not examining you to help your medical condition, but only for the purpose of forming opinions for the insurance company or at your trial.
  2. TELL THE TRUTH. Not only is this important generally, but it is really the best thing for your case. If something hurts, tell the doctor. If it doesn't hurt, tell the doctor. Be sure to discuss all of your physical and mental problems related to the collision. If you fail to tell the doctor something, the doctor will not be able to include it in his or her report and this may affect the value of your case.
  3. BE CAREFUL IN TELLING HOW THE COLLISION HAPPENED. The doctor is entitled to know generally how you were hurt. If he or she asks how the collision happened, discuss the incident in simple, general terms. For example: “My car was stopped and my car was hit from behind”, or “I was moving straight ahead and my car was hit from the side”, or “I was a passenger in a car that went out of control and turned over”, etc. However, avoid giving the doctor information about distances, time, speed or other such details relating to how the collision happened.
  4. BE CAREFUL IN TELLING ABOUT OTHER MEDICAL PROFESSIONALS. If you are asked what other doctors or medical professionals have told you about your medical condition, you should answer in a very general way. For example: “My doctor said that I will have trouble for the rest of my life”, or “my therapist says that I am getting better, but it is going to take time”.
  5. THE EXAMINATION WILL BEGIN AS SOON AS THE DOCTOR SEES YOU. The doctor (or his/her staff) may watch your movements in walking through the parking lot or when taking off your coat, etc. In addition, the doctor may use the distraction method by discussing one part of your body while paying attention to and examining another part of your body.

In most situations, it's better to attend the IME and cooperate with your insurance company's investigation. That may not always be the best option for you however and it may be necessary to consult with an attorney to discuss your options and the possible outcome of your decision.

About the Author

Scott Edwards

Scott Edwards is a partner at Schauermann Thayer Jacobs Staples & Edwards law firm. Scott is licensed in both Oregon and Washington, and has been practicing law since 2008. Though Scott started his career working for insurance companies, he now focuses his practice on personal injury, auto accident, biking accident, and insurance cases. In his free time, Scott enjoys spending time with his wife and children. He especially enjoys pedaling around the streets of Vancouver, Washington and Portland, Oregon on his bicycle.

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