What is an “Independent Medical Examination” (IME)?
PIP policies have provisions that allow insurance companies to ask for an “independent medical examination” or IME. An IME is usually triggered because (1) you have been treating for a certain length of time, (2) your treatment has surpassed a set dollar amount, (3) your PIP carrier has seen reference to a pre-existing medical conditions or a post-collision injury, (4) you have discontinuity of care (a gap in treatment, for example), or (5) an adjuster feels that there is some reason that your care is unreasonable, unnecessary, or not related to the collision. Your insurance will not ask for an IME because it is curious about your care. These examinations are expensive. They will typically ask for an IME because they are trying to cut off your benefits. For this reason, IMEs are routinely referred to as “insurance medical examinations” or “PIP termination examinations” among claimant’s lawyers.
State law requires that an IME doctor must be the same type of doctor as the treatment provider. Thus, your chiropractic care cannot be cut off by a medical doctor, or vice versa. If you saw more than one type of doctor, then you may have more than one IME doctor assigned to your IME.
At the IME, the examiner will take a detailed medical history. This usually lasts for about 30- 50 minutes. The doctor will ask about the facts of the collision, your symptoms, your treatments, changes in your symptoms, pre-existing conditions, post-collision injuries, and general medical history. The doctor will then do a medical examination. This typically lasts for between 5-15 minutes. The doctor will perform basic orthopedic and neurological tests. These include such things as testing reflexes, testing muscle strength, testing sensation, measuring ranges of motion, measuring anatomy (leg lengths, muscle circumference), palpation of injured areas, and standard orthopedic testing (walking on heels, walking on toes, tandem walking, balancing on one leg, cervical compression, etc.)
There are some doctors that regularly perform IMEs. These “usual suspects” get repeat business from insurance companies because insurance companies like their reports — they routinely cut off treatment.
I typically attend IMEs with my clients. It is kind of a scary procedure – having a doctor that you do not know and did not choose poke around at you – so I want to be there by your side. Also, observing the history and examination allows me to take good notes if new information comes up and allows me to look for shortcuts taken by the examiner.
If your PIP benefits are terminated, your policy has a provision for dispute resolution. In most policies, disputes are subject to arbitration. An arbitration is like a court proceeding except
that the decision maker is a lawyer or retired judge, the proceeding occurs in an office, and the methods of presenting evidence are somewhat expanded compared to a court trial. Your insurance company must pay the costs associated with the arbitrator. You must pay for the costs associated with presenting your case (the cost of expert witness testimony and attorneys fees and costs). In making a determination of whether or not to pursue a PIP arbitration, I look at several factors including (1) the amount of benefits that are in dispute, (2) the relative strength of the cases that would be put on by you and by your insurance, (3) the costs associated with presenting your case, and (4) the time and energy that would be associated with the arbitration.
If your treatment is cut off by an IME and it is not economically viable to pursue a PIP arbitration, then I will still try to collect your damages from the liable party under their third party liability coverage. Ultimately, it is easier to collect your damages when the PIP carrier has fully paid under your PIP coverage.
