Independent Medical Examinations: The Basics

After suffering an injury in a motor vehicle accident, your medical treatment and lost wages will presumably be paid by no-fault insurance. In New York State, no-fault insurance is mandatory; therefore, it is purchased as a package with your motor vehicle insurance. If you purchased car insurance that is valid in New York State, you are covered under no-fault insurance. No-fault insurance pays for your medical treatment regardless of who is at fault (hence the name, “no-fault”).  For more information on no-Fault insurance, visit our article regarding no-Fault benefits.

Once you begin receiving medical treatment under no-fault, the insurance company is entitled to conduct an Independent Medical Examination (IME). At an IME you will be examined by a physician who is hired by the insurance company. The purpose of the IME is for the insurance company to determine the extent of your injuries by a third-party physician. The IME physician is ostensibly impartial. However, it is important to keep in mind, the physician is paid by the insurance company. The insurance companies hire IME physicians in an effort to cut costs.  If possible, the IME physician will make medical findings that are favorable to the insurance company.  The IME physician is not on your side.  

Everything you say during your IME will be recorded and noted. You are not required to answer questions about the accident, and it is not wise to do so.  Do not volunteer information that is not requested.  Be forthcoming and honest about the extent of your injuries. Staying quiet about symptoms or pain experienced during the examination could lead the physician to determine you are fine.  However, exaggerating will have a negative impact.  IME physicians are trained, licensed professionals; they will know if you’re faking an injury or symptoms.

In the event the IME physician determines that you are not injured or no longer in need of medical treatment, the insurance company will terminate your benefits.  At which point, the determination may be appealed, or private health insurance may cover your treatment. However, a negative IME will undesirably affect your case, even where you suffered serious injuries. 

Generally, examinations by an IME physician are extremely brief compared to an examination by your treating physician. The IME physician may use your previous films and records to evaluate your injuries. However, the IME physician will usually only spend a few minutes assessing you. We request that our clients note which questions the doctor asked, the responses, the tests performed, and how long the examination lasted.

Failure to appear for an IME will result in termination of your no-fault benefits.  Additionally, the insurance companies are generally strict with scheduling; if you are late to the appointment, fail to reschedule an inconvenient appointment date/time, or request multiple postponements, the insurance company can deny your no-fault benefits. 

By the time you are schedule to appear for an independent medical examination, it is smart to consult with an attorney prior to being evaluated by the insurance company’s physician. Without guidance from an attorney, you could destroy the strength of your personal injury case, regardless of how severely you were injured in the accident. This information should not be supplemented for legal advice. For a free legal consultation, contact us to schedule an appointment.

Law Offices of Jennifer G. Tocci, P.C. (631) 343-7676 // //