Independent Medical Exams

An independent medical exam, or IME, is an examination arranged and paid for by the insurance company handling the claim, and the examiner works for that insurer. In Kentucky, an insurer seeking an exam for personal injury protection benefits must show the exam is material to the claim and obtain a court order for good cause, and Kentucky Rule of Civil Procedure 35 controls examinations ordered during litigation. The person examined keeps important rights, including the right to a copy of the examiner’s report. Sam Aguiar Injury Lawyers prepares clients before they walk into the exam room.

Insurer-Paid Examinations

Civil Rule 35 Examinations

Under Kentucky Civil Rule 35.01, when a party’s physical or mental condition is in controversy, the court may order an examination, but only on motion for good cause shown. In practice, the examiner is usually selected and paid by the insurance company or the defendant.

An IME is not a treatment appointment. The physician is not there to prescribe medication, order imaging, or make referrals. The purpose is a litigation report, which may address whether there is objective evidence of injury, whether the injuries fit the accident, whether the treatment was reasonable and necessary, and whether the patient has reached maximum medical improvement.

A defense examiner who works repeatedly for the same carrier can be cross-examined about how often that carrier hires the examiner, how much the examiner has been paid, and how often the examiner disagrees with treating physicians. Those questions do not erase the report, but they show the financial structure behind the opinion.

Independent Label

The letter scheduling an IME suggests an objective evaluation by a neutral medical professional. Nothing about the exam is independent, and it is designed to find reasons to deny or reduce the claim.

An investigation by The Globe and Mail reviewed more than 300 Canadian court and arbitration rulings and found many assessments by doctors conducting insurer exams were biased toward the insurance company that hired them. The same investigation reported that some doctors earn substantial income from these examinations. The more reliable a physician is for an insurance company, the more work that physician receives.

IME Doctor Selection

Most insurance companies keep pre-approved lists of IME doctors who are selected when the insurer wants to use an examination to deny or stop paying a claim. These doctors are not chosen at random.

The insurance company requesting the exam generally pays for it, and a doctor who knows who is paying has a reason to produce findings that fit the payer’s objectives. Judges and arbitrators have rejected IME reports as biased or incorrect, yet the same doctors continue to receive examination referrals. That pattern is part of insurance bad faith in Kentucky disputes.

Examination Risks

Many IMEs consist of 15 to 30 minutes of history-taking followed by a 5 to 15 minute physical examination. Despite that brief contact, lengthy reports often follow, concluding that no-fault benefits should end.

Claim-Focused Questions

IME questions focus on the claim rather than the person’s health, and the examiner looks for information the insurer can use to deny it.

No Doctor-Patient Relationship

The insurance company hires the IME doctor. There is no doctor-patient relationship, and the doctor is not there to treat the person or recommend care.

Documented Bias Findings

The Globe and Mail investigation found cases where judges and arbitrators rejected examiners’ reports for serious flaws, bias, and incorrect assumptions. A follow-up report found assessment companies asked medical teams to remove sections of assessments and downplay opinions about patients’ injuries.

Paper Reviews

In many cases, the doctor never sees the claimant and conducts a “paper review” of the medical file. Those reviews often conclude that severely injured people are fine.

Hostile Report Language

IME reports sometimes label people “fakers” or “malingerers,” and the opinions often conclude the person is “no longer disabled” or “no longer in need of treatment.”

Surveillance Around the Exam

Insurance companies may hire private investigators to watch claimants travel to and from the exam, sometimes filming in the parking lot outside the examination office. The comparison between observed activity and reported symptoms starts when the claimant leaves home.

Kentucky Rights Before an IME

Many policies require attendance at an IME, but in Kentucky that requirement is subject to the insurer’s obligation to show good cause. The Kentucky Department of Insurance personal auto checklist states that for personal injury protection claims, insurers shall not require an IME unless it is material to the claim, and only by a court order with good cause. A person asked to attend can:

• Ask whether the policy requires an exam
• Ask whether good cause must be shown
• Ask whether the insurer filed a petition for an order and request a copy
• Object to the petition
• Ask that a third party video-record the exam
• Request a copy of the report
• Decline to bring anything to the exam, including medical records

Kentucky is a one-party consent state: KRS 526.010 defines eavesdropping as recording a conversation without the consent of at least one party, so a participant may record the exam conversation. It is also worth identifying which records the examiner has and has not received, because insurers do not always send records that favor the claimant.

Conduct During the Examination

Consistent Answers

Exaggerating or downplaying symptoms damages credibility. Honest, consistent answers leave the examiner the least to use.

Exam Notes

Detailed notes written as soon as possible afterward should record the questions asked, how long the examination lasted, and which tests were performed.

Treating Physician Rebuttals

Showing the treating doctor the IME doctor’s conclusions often produces a rebuttal or contrary opinion. The treating physician examined the patient before and after the injuries, ordered and reviewed the imaging, tracked progress through treatment, and has no financial relationship with the insurer.

Legal Representation and IMEs

The term “independent” in independent medical examination is one of the insurance industry’s most misleading labels. The exams are business transactions designed to reduce payouts. Refusing to attend can jeopardize a claim, so the better course is to attend prepared, with realistic expectations and legal representation.

An attorney can enforce the right to video-record the exam, confirm the examiner has the complete medical records, and challenge flawed findings in the report with medical evidence.