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Independent Medical Evaluations and PIP

Why there is nothing “Independent” about Independent Medical Examinations

What is an Independent Medical Evaluation?

As a person who has been treating with a physician after a crash or a medical provider, a common term heard thrown around is Independent Medical Evaluation. Better known by its acronym IME, an Independent Medical Evaluation is used by insurance companies to “investigate” and evaluate if continuing treatment is necessary. Better yet, it is usually used by insurance companies to “cut-off” someone’s benefits. Meaning, even though every month you have paid your car insurance bill on time, and you should be afforded $10,000 in PIP benefits, as a result of this “independent” evaluation, they can stop making payments to your medical provider. This is even true if you have Medical Payments Coverage (“Med-Pay”).

Do I Need to go to an IME?

The simple answer is yes, if you are requested by your insurance carrier to attend an IME, you should work with them to schedule a time that works for you to attend. But why do you need to?

Pursuant to the Florida No Fault Statute 627.736(7)(a):

(7) MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON; REPORTS.—

(a) Whenever the mental or physical condition of an injured person covered by personal injury protection is material to any claim that has been or may be made for past or future personal injury protection insurance benefits, such person shall, upon the request of an insurer, submit to mental or physical examination by a physician or physicians. The costs of any examinations requested by an insurer shall be borne entirely by the insurer. Such examination shall be conducted within the municipality where the insured is receiving treatment, or in a location reasonably accessible to the insured, which, for purposes of this paragraph, means any location within the municipality in which the insured resides, or any location within 10 miles by road of the insured’s residence, provided such location is within the county in which the insured resides.”

Based on the above provision, if you were to refuse to participate in the examination, they would cut-off your benefits for failure to comply. Meaning your bills, from PIP coverage would not be paid further. Sometimes this happens due to you moving homes, changing phone numbers and them not being able to reach you. If that is the case, and they do not make reasonable efforts to reach you, then they would be unwarranted in cutting off your benefits.

Is an IME really “Independent”?

From my experience on the Defense side of insurance and on the Plaintiff’s side of insurance, the simple answer is NO. So how does the insurance company “choose” this doctor?

Insurance companies claim their choices are random, however, just like shooting for fish in a barrel, if every choice they can “randomly” choose from is going to give them the answer they desire, then nothing is independent.

The insurance company adjuster “randomly” chooses, sometimes in a rotation a vendor. A vendor is a company that hires physicians to do IMEs. The vendor then chooses the doctor to do the IME. The argument by the Defense is that they have no control over the doctor, but that is a thinly vailed lie. The doctors are part of these vendors because they provide the type of answers that the insurance company is looking for; i.e. that your benefits should be cut-off. I have heard that if the doctor comes back too many times with recommendations to continue coverage, that doctor will no longer be used for IMEs. So the doctors that are being used for IMEs are being paid, by the insurance company, to give them the answers they desire. If that isn’t the opposite of independent, I don’t know what is.

How much do these doctors make off of working for Insurance Companies?

Most people would be shocked to know that some physicians make millions of dollars a year just working for insurance companies. Some do not even treat patients anymore, they make 100% of their yearly income accepting money from insurance companies.

So what does this mean to you?

It means you are fighting against a system that does not want to pay you and your doctors for the medical treatment you deserve and need. I have litigated cases where the person had to have neck surgery right after they cut off benefits, because on-going treatment “was unnecessary”.

What should you do?

When you have millions of dollars working against you, you need adequate legal representation to fight against this system. You need someone who has experience fighting insurance companies for their clients. You need someone like the attorney’s at Dolman Law Group, who day in and day out fight for every last dollar of your PIP and Med Pay Benefits. If you are a medical provider or a patient who has been in an accident and they are trying to send you to an IME, please call Dolman Law Group at 727-222-6922 or email Derek@dolmanlaw.com to speak to me about your options.