Insurance Company “Independent” Medical Exams After An Accident

Your Independent Medical Exam Isn’t Independent At All

Three months after your accident on the Gene Snyder Freeway, you’ve been receiving treatment for your back injuries. Your doctor says you need continued physical therapy and possibly surgery.

Then a letter arrives from the insurance company:

“We need to schedule you for an Independent Medical Examination with Dr. Smith to assess your current condition and treatment needs. This is a routine part of our claims process to ensure you receive appropriate care.”

The Truth About “Independent” Medical Examinations

The letter suggests that this examination is conducted for your benefit, an objective, unbiased evaluation by a neutral medical experienced. But here’s what that letter doesn’t tell you: there’s nothing “independent” about this examination, and it’s designed to find reasons to deny or reduce your claim.

A major investigation by the Globe and Mail reviewed more than 300 court and arbitration rulings and found that many doctors conducting IMEs provide assessments that are biased toward the insurance company that hired them. The investigation revealed doctors claiming that severely injured claimants were fine, often without even seeing the patient in person.

Research shows that IME doctors can earn a substantial income from insurance companies, with some earning hundreds of thousands of dollars or more per year solely from conducting these examinations.

The more reliable a physician is to an insurance company, the more work they receive and the more money they earn.

How Insurance Companies Choose IME Doctors

Most insurance companies maintain pre-approved lists of IME doctors, who are routinely selected when they want to use an examination to deny or stop paying a claim. They aren’t randomly chosen medical experts. These are carefully selected doctors with track records of helping insurance companies deny claims.

Independent medical examinations are generally paid for by the insurance company requesting them. If the doctor knows who is paying them, their findings are likely to align with the paying party’s objectives.

IME doctors who find claimants medically fit and able to work do so to protect their job security. Once they have a solid reputation for serving insurance companies’ needs, IMEs can become a healthy revenue stream.

Judges and arbitrators often reject IME reports for providing biased, erroneous, or incorrect assessments of claimants. Yet despite criticism in court cases, these same doctors continue to be used in countless other examinations.

Dangers of an independent Medical Exam (IME)

Most “examinations” are barely examinations at all, typically consisting of 15-30 minutes of history-taking followed by a brief 5-15-minute physical examination. Despite this minimal contact, these brief exams are often followed by lengthy reports concluding that no-fault benefits should be terminated.

Fishing Expedition

The questions during IME examinations are focused on your claim, not your health. Insurance companies expect IME doctors to fish for information that can deny your claim.

No Doctor-Patient Relationship

The insurance company hires the doctor performing the IME to conduct an examination. There is no doctor-patient relationship. This means the doctor is not there to treat you or provide recommendations to improve your medical condition.

Documented Cases of Bias

The Globe and Mail investigation uncovered specific examples of biased IME practices: Dr. Platnick received emails from State Farm Insurance thanking him for cooperating to settle claims, noting that his involvement was “essential to our efforts,” despite the requirement that doctors provide independent assessments. Dr. Lawrie Rexneck has had reports rejected by judges and arbitrators in at least 10 cases for serious flaws, bias, and incorrect assumptions.

Assessment companies were found to be asking medical teams to remove sections of their assessments and downplay opinions about patients’ injuries.

“Paper Review” Problem

In many situations, the doctor has never seen the claimant in person and has conducted a “paper review” by evaluating the person’s medical file. Yet these papers often conclude that severely injured people are fine.

Track Record Patterns

Research shows that when reviewing physician rosters from companies that hire doctors to conduct IMEs, many of the doctors have been licensed for more than 30 years, and many are past retirement age. These aren’t actively practicing physicians keeping up with current medical practices.

Hostile Report Language

It’s not uncommon to see IME doctors making horrible and nasty accusations in their reports, calling people “fakers” or “malingerers.” These opinions almost always conclude that a person is “no longer disabled” or “no longer in need of treatment.”

Insurance companies may hire private investigators to monitor you on your way to the doctor and back, sometimes even filming you in the process. Insurance companies may be conducting surveillance on you in the parking lot outside the examination office.

Parking Lot Test

The IME starts when you leave home. Be mindful of your behavior from the moment you step out. Insurers often conduct surveillance to compare your actions with what you report.

Protect Yourself When Asked For an IME

While you might be required to attend IMEs under most insurance policies, in Kentucky, this requirement is superseded by the insurer’s obligation to demonstrate “good cause” for the exam. Thus, you have rights:

You may ask the insurer whether the policy requires an exam.

You may ask the insurer if good cause must be shown.

You may ask the insurer if a court petition was filed to get an order for the exam.

You may request a copy of the petition.

You have a right to object to the petition.

If you do attend an exam, you have the right to ask the court to have a third party video-record it.

You have the right to record it yourself in Kentucky.

You have a right to be given a copy of the report.

It is not your responsibility to bring anything to the exam, such as medical records.

However, you may wish to identify what the examiner has (and has not) been provided. Often, insurance companies will not give the examiner records that favor the claimant.

During the Examination

Be honest and consistent

Avoid exaggerating or downplaying symptoms; honesty is crucial, as misrepresentation can damage your credibility.

Document Everything

Write detailed notes about the IME as soon as possible, including what questions were asked, how long the examination lasted, and what tests were performed.

Getting Your Own Medical Opinion

Sometimes, showing your treating doctor the conclusions of the IME doctor will make them so angry that they’ll gladly write a rebuttal or contrary opinion on your behalf.

Why You Likely Need Legal Representation

Insurance companies know that the doctor you’re seeing is likely operating with your best interests in mind, while their goals are directly contrary to yours. Having legal representation ensures your interests are protected throughout the IME process.

Attorneys can enforce your right to videotape the insurance company’s Independent Medical Exam and ensure the IME doctor has your complete medical records. These measures can handle ensure the IME is performed fairly and you are not taken advantage of.

Bottom Line on “Independent” Medical Exams

The term “independent” in Independent Medical Examination is one of the insurance industry’s most misleading. These examinations are anything but independent. They’re business transactions designed to handle insurance companies reduce payouts.

Understanding this reality doesn’t mean you should refuse to attend an IME, that could jeopardize your claim. Instead, it means going in prepared, with realistic expectations, and with experienced legal representation to protect your rights.

REMEMBER: The insurance company’s IME doctor works for them, not for you. Make sure you have someone working for you as well.