Frequently Asked Questions–“What is an Independent Medical Examination?”


Question:  What is an Independent Medical Examination?

Answer:  The Independent Medical Examination or IME is a medical exam conducted by the insurance company in the context of a either Workers’ Compensation, No Fault, or a lawsuit.

I.  The Purpose of the IME

In essence the insurance company has the IME in order to show that the client does not need further medical treatment and has reached maximal medical improvement.  This would be a ground for the insurance company to deny payment for further treatment.  This is typically done in Workers’ Compensation cases and No Fault.

Another purpose of the IME is to contest or defend against the client’s claims of injury.  For example, in Workers’ Compensation, the insurance carrier would have an IME in order to defend against the client’s claims of injury and permanency.  In a lawsuit, the defendant’s liability insurance company would conduct an IME in order to defend against the claims or to minimize the claims.

Many members of the plaintiffs’ bar feel that the term IME is misleading.  It really is not independent.  In nine out of ten times the IME doctor finds no injury.  The IME is part of the advocacy process in that the physician is taking an advocacy role.  Therefore, the IME should be called the Defense Medical Examination or DME.  Unfortunately, the term IME has become widely accepted in the industry, and it is unlikely that DME will subplant it. 

II.  The No Fault IME

In an auto accident where the client’s medical bills are being paid by the No Fault insurance company, that insurer must have an IME in order to determine whether further medical treatment is warranted.  The IME will also determine whether the client can return to work.

If the insurance company does not have an IME, then it cannot deny medical treatments which are related to the car accident. 

In 99% of the time the IME doctor will find that the injured client needs no further treatment and can return to work.  At this point the No Fault insurance carrier will cease paying for future treatment and lost income.

The insurance company can seek IME’s by various medical specialists, such as orthopedists, neurologists, and chiropractors.  It depends upon the nature of the injury and the types of doctors the client has been seeing.  Generally, the client will attend a few IME’s with various medical specialists.

The client must attend the IME.  A failure to attend could result in No Fault carrier denying all past bills and lost income on the ground that it has not had an opportunity to verify the injury and causation.  In less extreme cases the insurance company will deny only all future treatment.

III.  The Lawsuit IME

In a personal injury lawsuit the defendant, through its insurance company, can have a IME.  This is typically done after the client’s oral deposition.

In the lawsuit the IME is also called a physical exam.

The insurance company will designate a physician whose speciality covers the injury.  For example, in a case involving injury to the lumbar spine, the insurance company will hire either an orthopedist or a neurologist or both.  If a psychological injury is also claimed, then there will be an examination by either a psychologist or psychiatrist. 

The IME physicians will testify at trial in defendant’s favor.  Typically, they will counter plaintiff’s physicians’ claims of injury.  The defense IME doctor will say either that the client is not permanently injured or the client was never injured or the injury has fully resolved or the client has no disability affecting his work and general functioning.

Conclusion

The IME is part of our civil justice system.  Although the doctors are called independent, they are usually advocates for the defense.

When you are scheduled for an IME you should call us to discuss what you should do at the IME and what the doctor is allowed to do at the IME. 

Mark E. Seitelman, 7/31/08, www.seitelman.com.

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