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What is an independent medical examination?

IMEAn Independent Medical Examination (known and hereinafter referred to as an ”IME”) is a tool utilized by insurance carriers wherein they examine their own insured pursuant to their auto insurance policy in an effort to suspend their medical benefits or curtail their medical treatment under Personal Injury Protection (PIP).  Do not confuse an IME with a CME (Compulsory Medical Examination), which is discussed under a separate question.  For the purpose of this discussion, an IME, is ordered by your insurance carrier prior to a lawsuit being filed.  CME’s are requested by either insurance carrier (i.e., the at fault party’s carrier or your own insurance carrier) when the case is in litigation as a tool to defeat the lawsuit or at least mitigate damages.

Keep in mind that there is very little that is “independent” about this type of examination.  The IME, is generally conducted by a physician retained by the applicable insurance carrier.  We have seen the same IME physicians time and again.  In fact, IME physicians often produce the same report over and over regardless of the complaints and presentation of the injury victim.  The insurance carrier hand picks the IME physician based on prior experiences and what they can expect.

In order to seek an IME, the insurance carrier must show that the mental or physical condition of an injured person who is covered under PIP is material to a claim for first-party medical benefits.  If the mental or physical condition of the claimant is at issue, the applicable insurance carrier can require the individual submit to an examination.

Only a physician licensed under the same statute as the treating physician can generate a report that the insurance carrier can utilize to withdraw, reduce or deny benefits for medical expenses. United Automobile Insurance Co. v. Viles, 726 So.2d 320 (Fla. 3d DCA 1999).  In other words, an insurance carrier can rely on a report generated by a Chiropractor from an IME to cut off, deny or reduce medical bills generated by the treating Chiropractor.  An Osteopathic Physician can do the same to a fellow Osteopathic Physician, Neurologist can respond to a Neurologist and so on.  Subsequent case law stands for the proposition that a report from an IME is not necessary to deny benefits only to withdraw (cut off) benefits[1].

It is essential to note that the insurance carrier has a fundamental right to an IME.  A refusal by the insured to submit to an examination or failure to attend said exam will constitute a material breach of the insurance policy (i.e., contract) and can serve to completely release the PIP carrier from liability for further payments to be made on medical services rendered[2].   However, the failure on the part of an insured to attend the IME is not necessarily deemed to be an “unreasonable refusal” to attend[3]. The Florida Supreme Court ruled (in Custer) that an insured’s attendance at an IME is not a condition precedent to the existence of PIP benefits.  Id, at 1097.  The insurance carrier has the burden of proving the insured’s failure to attend was unreasonable.

At Dolman Law Group, we typically videotape IME’s and tape every last CME without exception.  It is important to tell the physician all of your complaints.  By videotaping the examination, we are able to compare and contrast what the IME physician performed against the treating physicians, who often are far more thorough.

References:

[1] Partners in Health Chiropractic v. United Automobile Insurance Co., 21 So.3d 858 (Fla. 3d DCA 2009)
[2] Allstate Insurance Co. v. Graham, 541 So.2d 160 (Fla. 2d DCA 1989)
[3] Custer Medical Center v. United Automobile Insurance Co., 62 So.3d 1086 (Fla. 2010)

Posted in: Your Car Accident and You