1. What is an Independent Medical Exam (IME)?
An IME is an Independent Medical Exam. It is an exam set up by the insurance company.
Th insurance company will refer to the exam as an “independent” medical exam, but there is nothing independent about it. The exam is requested by insurance companies to look for reasons to deny your claim. The IME doctor is chosen by the insurance company. The exam is not part of your medical treatment. Ninety percent of all IME reports cut off the injured person from treatment paid by PIP.
While many states have some form of personal injury protection, the information here applies to Oregon law, especially on how a lawyer can help force your PIP carrier to pay your medical expenses and wage loss.
2. Why am I being sent for an Independent Medical Exam (IME)?
An independent medical exam is used by the insurance company to stop paying your medical bills and wage loss. The doctor is not there to treat you or to help you get better. The IME doctor will likely report that you do not need any additional treatment, or that the treatment is not related to your collision.
Possible reasons why the insurance company is sending you to an IME:
There was not much visible damage done to the car you were in.
Insurance perspective: If the car doesn’t appear to be badly damaged, any injuries you have must be minimal.
Reality: People can be severely injured in traffic accidents even if there is little or no damage to the vehicles. For example, if your head or body is turned at the time of impact, you’re in a more vulnerable position. Also, some people are more fragile than others. Some people walk away from a violent crash in which the cars are destroyed, while other people can be injured when there is no car damage at all.
You have prior similar injuries or treatment.
Insurance perspective: If you had a similar problem in the past, your current injury must be caused by that.
Reality: Just because you may have had an injury before the collision does not mean you can’t be injured again. Oftentimes people injure certain body parts more than once over the course of a lifetime. A sprained neck in the past doesn’t mean it’s impossible to have another sprained neck later.
There was a gap in your treatment.
Insurance perspective: If you were truly injured, you would be treated for it regularly. If there are any gaps in your treatment it means that you stopped because your injury resolved and the need for more treatment later must be the result of something else.
Reality: Doctor’s availability, transportation, work obligations, or the lack of insurance can result in a gap in treatment. Sometimes injuries seem to have healed, but the symptoms return after the patients start to resume their normal lifestyles.
There was a delay in treatment.
Insurance perspective: If you experience a delay in symptoms or treatment, those injuries must have been caused by something other than the motor vehicle accident.
Reality: After an accident, there is typically shock and adrenaline that can overshadow injuries. It can take time for some injuries to be felt. More severe injuries can mask less severe injuries. Some injuries progress over an extended period of time. Just because an injury isn’t instantly reported doesn’t mean the later symptoms are unrelated.
There was a subsequent injury.
Insurance perspective: If you need more treatment, it is because something new happened.
Reality: Your injury can be made worse by something that happens later. A past injury can also make you vulnerable to a future injury. If your motor vehicle injury has contributed to a later injury, the PIP insurer may still be responsible for the additional care you need.
You should have already recovered.
Insurance perspective: Injuries heal within defined periods of time. You should be done treating.
Reality: There is no way to determine when an injury will fully heal. All people are different and injuries range in severity and recovery time. Some people may fully recover from their injuries while other people may never fully recover.
3. Do I have to go to the Independent Medical Exam (IME)?
Insurance companies cannot force you to go to the exam. However, if you refuse to go, they will cut off your medical treatment. If you decide to attend the IME, they will still probably cut off your medical treatment and wage loss benefits. By going to the IME you will be in a better position to force them to pay for your accident-related medical treatment and wage loss with the help of a lawyer.
The decision to attend the IME is best made with the advice of an attorney. Experienced personal injury lawyers are usually able to help most people get the medical treatment they need. Keep in mind that someone can go with you to the IME, but only as an observer. This person may take notes, but should not say anything during the exam.
4. What are the effects of an Independent Medical Exam (IME) on my treatment from a car accident?
The primary effect of the IME is that the insurance company will more than likely refuse to pay for any additional medical treatment.
Don’t let the IME stop you from getting the treatment you need.
Talk with one of our attorneys about your options. We’ll answer your questions free of charge.
Your health and wellness should not be compromised by the cost-saving decisions of the insurance company.
5. What do I need to know about the Independent Medical Exam (IME) doctor?
They’re hired by the insurance company.
Insurance companies typically hire doctors who will dispute your need for future medical care, look for information to discredit your claim, say that your injuries are unrelated to the accident and write a report to favor the insurance company.
The IME doctor is not your doctor.
Do not expect neutrality. The insurance company is not hiring a doctor to help you get better. The vast majority of the time, IME reports will state that the patient doesn’t need additional treatment, even if the patient has not yet fully recovered.
6. How do I prepare for the Independent Medical Exam (IME)?
Preparing yourself for your insurance medical exam can help you get the treatment you need and deserve. Here are some general guidelines to help you prepare for your insurance medical exam. But there might be exceptions in some cases. It’s best to talk to an attorney to help you get ready for the IME.
- Don’t say more than you have to.
Listen carefully to what the doctor is asking you. If the doctor’s question is not clear, tell the doctor you don’t understand the question. Once you understand the question, keep the answer short. You want to fully answer the questions, but with as few words as possible.
- Don’t say anything you don’t know to be true.
Of course, the worst thing anyone can do is lie, but guessing can be just as bad. It’s okay to tell the doctor that you don’t know or aren’t sure of the answer to a question. If you can provide an approximate answer, that’s fine. But don’t guess or make something up. If you guess wrong, the insurance company will treat it as a lie.
- Keep your answers short.
It’s important to give accurate and complete answers, but keep it brief. If you are required to describe a situation, a sentence or two is enough. We are taught to be thorough with our medical providers so that they will be better able to treat and heal us. However, IMEs are different. The more information you give the IME doctor, the better opportunity the insurance company will have something to use against you.
If the doctor doesn’t ask you a question that you think is important, that’s the doctor’s problem, not yours. Remember the rule: don’t volunteer information.
- If they don’t ask, don’t tell.
You may feel the urge to tell the doctor why you need more treatment or how your injury is directly related to the collision. However, this is not the time or the place to advocate for yourself. You have two simple jobs to do at the IME:
- Let doctor examine you.
- Answer the doctor’s questions.
- Be consistent and confident.
Maintaining your credibility is important. If you answer a question that is not consistent with your medical records, the doctor will highlight that in the report. The insurance company will say that you were not being truthful and you should not be believed. So, what’s the rule here? Don’t guess!
- Provided you’re asked, tell the doctor about similar injuries or health conditions you have had in the past — even if you made a full recovery.
If you tell the doctor something that doesn’t match your current or past medical records, the insurance company will accuse you of being dishonest.
7. What do I tell the IME doctor if I have had similar problems in the past?
Most people have had some injury or issues with the neck or back. What’s most important is that you spend time thinking about past injuries or issues- that way when you’re answering a question about the past, you are not guessing. The closer in time to the accident you had neck or back issues, the more important it is that you are accurate.
Do not be afraid of telling the IME doctor about past similar issues protecting your credibility is what’s most important. Remember to keep your answers short and to the point.
The IME doctor is aware of your past medical treatment. The PIP carrier will make sure they have all of your past records.
8. What is the biggest mistake I can make if I’m going to an IME?
The biggest mistake you can make is to stop getting the medical treatment you need.
It makes a lot of sense why you may feel like you have to stop getting treatment. Medical care is expensive. No one wants to have unpaid medical bills.
Our goal is to give you advice so you can make the best decision concerning your medical treatment and recovery. If we believe we can get you medical bills paid, we’ll let you know. Whatever concerns we have about getting your treatment paid by PIP, we will let you know.
9. What’s most important when you’ve been injured through the fault of another?
Getting the medical treatment you need to have a full and speedy recovery.
Making sure that your medical bills are paid.
Insuring that you are making the best possible medical treatment decision for yourself, based on the facts of your case.
10. What will it cost me to talk to an attorney about the Independent Medical Exam (IME)?
We help 100’s of people a year who are not our clients prepare for their IME free of charge. Give us a call, we’re happy to help you.
Even if you don’t want to hire an attorney, it’s a good idea to get a free consultation.
We’ll help you determine whether you have a case and if you need an attorney. It doesn’t make sense to hire a lawyer if you don’t need one.
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