To avoid making payments, insurance companies set a high bar for payees to overcome. Said differently: Whenever money is at stake, evidence is required. Accordingly, in lawsuits where a plaintiff wishes to recover compensation in order to pay for medical bills and accident-related expenses, insurance companies and/or at-fault parties require proof of injury before they’ll accept directives to make payment(s).
Yet, even with this general legal standard, it can be difficult to know when you need an independent medical examination for your lawsuit, workers’ comp claim, or insurance petition. To help with this assessment, we’ve outlined when independent medical examinations are necessary.
For more information, please continue reading. Or, if you would rather speak with a member of our team directly, contact Schwartzapfel Lawyers today at 1-516-342-2200.
What Is an Independent Medical Examination?
In a nutshell, an independent medical exam (IME) is a health care checkup performed by an independent” party. Independent in this sense means a doctor who does not work for you in a legal dispute, such as a workers’ compensation case. In IME terms, the person receiving the exam is a claimant.
The broad purpose of an IME is to determine the validity of a person’s medical condition for legal claims. For example, an injured worker who broke their leg while on the job claims that they are entitled to compensation. The insurance company is willing to comply but first orders an independent medical examination. The IME double-checks that the worker’s leg is actually broken so that the insurance carrier is not scammed based on a false claim of impairment.
Importantly, different states have specific rules on who can choose the medical professional to perform an independent medical examination. For example, some states require that the insurance company choose the doctor while others require the doctor instead be picked from a list.
Independent medical evaluations can also be important for you if you were injured and are trying to recover compensation from an at-fault party. An IME can identify your injuries, prove how you were injured, and serve as important evidence in court, should an insurance company or other organization not wish to cover your damages.
Why Are Independent Medical Examinations Necessary?
There are two broad reasons why you may need an independent medical examination:
- The defendant or insurance company in a case requires medical proof of injury before they will pay you money for medical bills and related costs
- The defendant or insurance company for a case does not believe or disagrees with a decision by your treating doctor about your injuries, their severity, their cause, or your course of medical treatment
For instance, imagine a case in which a construction worker falls due to employer negligence, injuring their ankle. According to their doctor, the injured construction worker will require extensive surgery to recover full mobility.
The insurance company for that construction workplace, however, disagrees with this assessment. It wants to make sure that the injured worker receives the exact amount of money needed, not extra for an unnecessary surgery procedure.
Thus, they order an independent medical examination. Note: Independent medical examinations can also be ordered by a judge or hearing officer to resolve disputed issues, such as the extent or severity of injuries sustained in an auto accident.
In both cases, the core need for independent medical examinations is distrust. If both parties in a court case or dispute agree on the injuries sustained, their severity, as well as necessary medical expenses, independent medical examinations are not usually necessary.
To learn more, contact Schwartzapfel Lawyers today for your free consultation. Simply dial 1-516-342-2200 and allow us the honor and privilege of answering any questions you may have.
Cases Where You May Need an Independent Medical Examination
There are many cases in which you might need an IME. These include but are not limited to:
- Personal injury cases in which you try to recover compensation from an at-fault or negligent party. These include slip and fall cases, product liability cases, and much more.
- Auto accident cases as described above.
- Workers’ compensation claims. Insurance companies typically require independent medical opinions before paying injured workers what they are owed.
- Any case in which your doctor recommends an expensive procedure like surgery or ongoing physical therapy and the defendant in the case must pay for that treatment and/or procedure.
- Any case in which your injuries may result in permanent disability. An independent medical opinion is sometimes warranted to make sure that defendants pay what is rightly owed to the plaintiff over time.
Your lawyers can tell you whether an independent medical examination is necessary for your case. Again, it depends on whether you and the defendant in the case trust each other, or if the injuries sustained were particularly severe or debilitating.
Generally, the more complex and potentially severe the injuries are, the more necessary an independent medical examination is. That’s because more money is on the line, so both sides need to make sure medical opinions are accurate.
Who Selects the Doctor for an Independent Medical Examination?
Because independent medical examinations are supposed to be objective, you cannot pick the doctor for an IME. As mentioned above, each state has its own rules about who gets to select the doctor for an IME.
If an insurance company requests an IME, that insurance company typically will choose the doctor who performs the analysis. Note that this could mean the doctor can’t be trusted. Many independent medical examiners get payments from insurance companies. That means they have an incentive to lower the costs for insurance companies and lower your benefits proxy.
Your lawyer can point this out if you need to contest the results of an IME in the future. Contact Schwartzapfel Lawyers today at 1-516-342-2200 if you believe your IME doctor to be untrustworthy.
Significantly, you may be able to request an IME if you disagree with the opinions of your treating doctor. In this case alone, you can choose the evaluating physician since you are the one who doesn’t trust the initial medical opinion.
Other states choose independent medical examiners from completely random lists of qualified specialists. They may also have judges in court cases choose independent medical examiners instead. Regardless, speak to your lawyer about the selection process so you are prepared ahead of time.
How to Prepare for an Independent Medical Examination
When preparing for an IME, it’s generally a good idea to:
- Gather all of your medical information together and put it in a folder. Then, you can present this folder to the independent medical examiner or anyone else as necessary to make sure they have the appropriate context for your injuries and/or conditions.
- Bring a friend with you to the independent medical examination. This person can act as a witness during the exam and also take notes about what the doctor asks, how they act, how they perform, and other details you may not remember afterwards.
Note: The latter step can be especially important if you need to contest the results from an IME report.
The Independent Medical Examination Process
Immediately prior to an independent medical examination, any medical records or relevant documents will be sent to the IME professional. The doctor can then decide whether to review the documents before or after the examination begins.
If the medical issues in question are highly contested or worth a large sum of money, your insurance company might write a letter to the doctor explaining the injury and posing specific questions. Consequently, the doctor may decide to frame their examination based on those questions.
For instance, if you injured your knee at work and your physician believes that you’ll need surgery, the insurance company for your workplace may ask the IME examiner to specifically determine whether surgery is necessary. However, some examiners perform thorough checkups regardless and investigate all aspects of your health or related injuries as needed.
IME doctors might answer questions such as:
- Whether an injury or condition has been diagnosed correctly
- Whether a work-related accident caused current symptoms and/or injuries
- Whether a car accident or other incident caused the plaintiff’s injuries
- Whether additional medical testing or treatments are necessary for the condition/injury
- Whether the injured individual will be able to return to work in the case of workers’ compensation claims
- Whether an injured worker should have any restrictions as to what they can do at the workplace, such as lifting heavy objects or bending down
- Whether the injured party has a permanent disability and, if so, the extent of the disability and what the individual will need to maintain his/her quality of life
For more on the IME process, or for answers to questions that are specific to your situation, please call Schwartzapfel Lawyers now at 1-516-342-2200. Your consultation will be free and the advice offered to you may save you miles of headache, heartache, and financial strain down the road.
Is There Doctor-Patient Confidentiality Within an IME?
It’s important to note that there isn’t a legally binding physician-patient relationship during an independent medical examination. Thus, you should not expect any confidentiality between you and the doctor and will need to consider your words carefully. Remember: Anything you tell the independent medical examiner may later be used against you.
Naturally, you should answer all questions honestly. Still, it is likely in your interest to speak with your lawyer before going to an independent medical examination so they can coach you on how to behave and what to say. This will ensure the IME report is helpful to your case rather than a hindrance.
Reviewing the Independent Medical Examination Report
After an IME concludes, the doctor should send their report of the examination to you, your lawyer, and anyone else involved in the case. The judge may receive an independent report, as will your workers’ compensation insurance company or the defendant in the lawsuit.
Please note: You have the right to review this report immediately. It should begin with an introductory segment that describes the dates of the injuries sustained as well as other basic medical info. It should also include a summary of the examiner’s conclusions.
Next, you and your lawyer should look through the conclusions one at a time. The right lawyer will be able to advise you on whether the IME report is beneficial to your case or potentially damaging. From there, you can consider your legal options, including contesting the findings in the report if needed.
For example, if you receive an IME report and it claims that you don’t need surgery for an injured knee, you can contest this by:
- Ordering another IME
- Countering the evidence provided with evidence from your primary care physician
- And more!
Schwartzapfel Lawyers can break down all important IME information and make sure you understand what it means. If you already have an IME report, contact us today at 1-516-342-2200 for a free consultation.
Do You Always Have to Attend an Independent Medical Examination?
Generally, independent medical examinations are mandatory. That means, when scheduled, you have to attend.
Independent medical examinations are important for testing the validity of injury claims and ensuring that workers’ compensation insurance companies pay appropriate amounts, especially for major disabilities or long-term injuries.
Courts can compel you to attend independent medical examinations if you’ve filed a lawsuit claiming to have suffered physical injuries. Accordingly, even if you don’t wish to submit to an IME, you may still be compelled to do so by court order. Note: This power extends to the vast majority of personal injury lawsuits, regardless of circumstances.
As well, should you not attend an IME, you risk having your lawsuit dismissed. The same is true for workers’ compensation cases.
This is because the insurance company or defendant in a legal case has the same rights as you to make sure you’re presenting your account honestly and fairly. Specifically, they have the right to verify that your injuries and harms are as severe as you claim in order to prevent bad actors from abusing the system and committing fraud.
How Can an Independent Medical Examination Affect Your Case?
Given the importance of an independent medical examination, it can drastically affect your workers’ compensation case and other legal pursuits.
After an IME concludes, your doctor will write a report with their conclusions and/or opinions. Most of these will relate to the questions and issues raised by an insurance company or disputing defendant.
Depending on those opinions and conclusions, you could see results or effects in the form(s) of:
- Your requested damages or compensation being upheld by the judge
- Your requested damages or compensation being reduced or increased based on the medical opinions reached by the doctor
Note, too, that while you and your legal team may be able to contest the opinions of an IME, most judges view independent medical examiners as objective. Thus, their opinions usually carry substantial weight (even if this is not true from your perspective).
There are, however, certain areas in which you can challenge an independent medical examination report. For instance, if the doctor has an opinion based on incorrect information about the events that led to your injuries or your medical history, you can point out and potentially get a new IME ordered.
Alternatively, you can write a letter to the doctor and/or insurance company explaining any other factual mistakes you notice. To do so effectively, you’ll need to present additional evidence supporting your position. And while this can be a difficult task to handle alone, your law firm can help you with this and any other steps throughout the appeals process.
If you can’t effectively dispute the statements in an IME report, or if your issues are ongoing and you are looking to have them resolved, you should consult with a workers’ compensation attorney quickly. The right lawyer can help you avoid having your benefits or damages cut off by an IME report. They can also help you file effective objections, schedule depositions to question the independent medical examiner, and so much more.
Contact Schwartzapfel Lawyers Today!
On balance, you may need an independent medical examination in order to recover money from an insurance company or at-fault/negligent party. However, IMEs are not always required. This decision will depend on the circumstances of your case as well as the severity of your injuries and the projected medical costs for treatment. The right law firm can help you determine whether an IME will be necessary for your case or if your trust in one doctor’s opinion should be sufficient.
When you hire Schwartzapfel Lawyers, you hire knowledgeable legal professionals who’ve seen it all and who can help with your workers’ compensation case. Should your insurance company demand an independent medical examination, we’ll help you prepare for the IME and guide you through the process from start to finish.
As soon as you contact us online or at 1-516-342-2200, we’ll begin fighting for you™ and won’t stop until damages are recovered and you have been made financially whole.
Sources:
Schwartzapfel Lawyers, P.C. | Fighting For You™™
Independent Medical Examination | FindLaw
Tips for the Independent Medical Examination (IME) in an Injury Claim | Nolo
