Insurance "Independent" Medical Examinations (IME)



Overview and Background



The so-called "Independent" Medical Examination (IME) is a tool used by the insurance industry to assess for itself a number of issues relating to your claim (as discussed below), to deny further access to medical (we will use the word "medical" throughout this Section to include all forms of care, including chiropractic, physical therapy, acupuncture, and any other forms of "alternative" medical care) care, and to attack the conclusions of your own doctors. It is a legitimate exercise of contractual right in first party** claims, and a right granted by case law or court rule in third party** disputes. Even if you are not involved in litigation in your third party** claim, you can expect to receive a request that you participate in an IME if you have had a significant prior injury, extensive medical care from this accident, or if you are receiving many treatments from a doctor or dentist the insurance company may have identified as too likely to favor claimants.

The IME allows the other side to assess your medical condition, and to gather some legitimate information on your medical history, the trauma involved in the accident, the relationship between the trauma and the injuries you contend resulted from it, the reasonableness and necessity of your medical (here we speak of all treatment-medical doctor, surgeon, chiropractic, massage, alternate, etc.) treatment and associated costs, the extent to which the injuries may interfere with your life, and the prognosis for the future.

In concept, the IME is an entirely appropriate tool. It provides the tort system a useful check and balance against any potential abuses of the system by either the claimant or his treating medical team. Although we cite abuses of the IME power in this section, make no mistake that we feel it is a necessary tool to ensure only appropriate sums are paid for medical treatment, wage loss, and general damages. Ideally, the exam would be one made by a doctor in the area where the claimant resides who is in the same area of medicine as the treating doctor, and who also has a practice in which only a small percentage of work is done for the insurance industry. One would naturally expect such an examination and ensuing report to be truly objective, and hence, "independent."

However, in recent years, a number of doctors have begun to specialize in working for the insurance industry; in other words, they make a substantial part of their living from conducting these examinations. How much continued work do you think they would get if they always issued reports that supported the claimant's request for continued medical treatment, or reports that usually agreed that the claimant's life has been one of continuous pain and suffering since the accident?

As to these doctors, the title of this section is surely one of the grand misnomers in the personal injury business. There is ABSOLUTELY NOTHING "INDEPENDENT" about the jackals who devote 90% of their medical "practice" to performing medical examinations for the insurance industry, or who subsist in large part on grants sponsored by the insurance industry.

An insidious real-life example of the latter is a dentist who works as a teacher, practitioner, and researcher at a major university, but who receives a large governmental grant ("sponsored" by the insurance industry) as a researcher to prove that more Temporalmandibular Joint Dysfunction (TMD) cases are due to stress in a patient's life as opposed to accident trauma, and, furthermore, that almost all TMD cases can be treated conservatively, without the mouth appliances or surgeries recommended and used by the claimant's treating dentists. This individual is a bonanza for the insurance companies, who also pad his wallet with payment for a very high number of IMEs and court testimony cases each year. With such a background and source of income, what do you suppose would be the chances that this dentist would EVER agree with the findings of the claimant's dentist as to the cause of the TMD and the need for the use of mouth appliances or surgery to cure the problem?

This person is regularly selected by the insurance side to perform IMEs and to testify in court. As you might expect, he makes a devastating witness for the tortfeasor's ** side because the jurors tend to look favorably upon university teachers as "objective experts", and at the same time he nearly always attacks the findings of the treating TMD dentists as to both causation and recommended treatment.

The selection and exclusive use of such "consultants" to perform IMEs is becoming the most effective way for many insurance companies to: 1) deny their own insureds payment of legitimate medical (we will use the word "medical" throughout this Section to include all forms of care, including chiropractic, physical therapy, acupuncture, and any other forms of "alternative" medical care) expenses required for reasonable and necessary continued medical care (in first party** claims); and 2) to undermine the testimony of a claimant's own medical doctors by use of marginal and sometimes spurious arguments (in both first party** and third party** claims).

We certainly do not include most insurance companies in this indictment, since most make judicious use of their power-nor most IME doctors, who are thoroughly professional and fair-minded in making their examination and report.

But there is such an obvious trend in recent years toward abusive use of this IME tool, that we advise all claimants to be generally aware of the topics in this section, and for those who have been requested to undergo an IME, this is "MUST" READING.