In a prior post, I briefly touched on what is referred to by insurance companies as an “Independent Medical Examination” or “IME.” This is a term that is used by the insurance industry to make it sound as if an “independent” third person is going to look at a patient and their records and come to a determination as to whether or not an injury has occurred that requires continued treatment. Let me first set the stage for how a person ends up in a situation where they are required to attend an IME by their insurance company.
Let’s say I get into a car accident on my way home from work tonight (I really hope this doesn’t come true) here in North Dakota, and I am hurt. I wake up tomorrow with pain in my neck and my back and decide to go to see a chiropractor or a physician. I have car insurance that protects me, and it follows the no-fault system in North Dakota, meaning I have up to $30,000 available for me to use for medical bills (oftentimes referred to as “PIP” coverage). That’s great, I feel protected. I am happy I have someone who is going to be covering my bills. I continue treating for four weeks, and then out of the blue I get a letter in the mail from my insurance company saying I need to contact an agency they work with to set up an “Independent Medical Examination.” What? But I’m hurt. My doctor/chiropractor even says so. Why do they need me to see someone to verify what my treating provider already confirmed?
Is this something I am required to do? Yes. In North Dakota, the statutory law requires insureds to submit to medical examinations, which is found in North Dakota Century Code Section 26.1-41-11. Also, your insurance policy most likely has language in the contract where you have (1) agreed to cooperate with the insurance company in their investigation of your claim, and (2) agreed to attend an IME if requested to do so. Therefore, if you refuse to attend the medical examination, you will be denied all benefits moving forward.
Now that I know I have to do this, I call the agency and get set up to see the doctor/chiropractor the insurance company has chosen for me to see. I sign an authorization, and they obtain my medical records from my treating providers. I also see on the paper the agency sends me that I am not allowed to make any recording of the appointment. Why? That’s certainly strange. Why would the person I see not want a recording to verify that the report he/she puts together is accurate? In my opinion, it’s because they don’t want an actual record that can dispute what they say happened. How is that independent? If everyone is being transparent here, there should be no issues with recording the appointment on a digital recorder.
The day comes and I go to the examination. The doctor/chiropractor talks to me for 5-10 minutes. He or she then does some minor tests but does not provide me any treatment. I tell them about the pain I am having, and that I didn’t have this pain prior to the accident. The doctor/chiropractor seems nice and seems like he/she agrees that I am hurt. I think all is just fine, and then I receive another letter from my insurance company saying they are no longer paying for my treatment.
I read the letter, and the IME report is attached. The IME report contains a bunch of things in there that I never said and states that I only suffered a soft tissue injury that should have healed in 4-8 weeks. What? But I am NOT better, I DIDN’T heal. How can he/she do this? I told my doctor/chiropractor, and they completely disagree with this “Independent” doctor/chiropractor.
Now I start to really wonder, how is this independent at all? He/she was paid by the insurance company, and it appears to me they only heard what they needed to hear to be able to deny me benefits. I am now starting to figure out that it would likely be in the doctor’s/chiropractor’s interest to keep this insurance company happy, so they get repeat IME referrals. I wonder how many of these they do a year? I wonder how many times they have said this exact same thing to others? I wonder how much money they make in a year simply doing IME reports? I wonder if they have ever even given an opinion that is contrary to the insurance company’s interest of not having to continue to pay for treatment. In my opinion, “IME” should really stand for INSURANCE MEDICAL EXAMINATION, because there is nothing independent about this process at all!
Wouldn’t my doctor be more independent, considering he/she has my best interests that he/she has to look out for in simply providing me medical care? If my treating provider thought I was faking my injury or that I was not injured, they would tell me that and quit treating me. In fact, they have shown me the X-ray/CT Scan/MRI that proves I am hurt. How am I going to be able to get better? I can’t pay for all of this treatment myself?
I have read enough of these IME reports knowing that each one reads the same way. The reports usually state that allegedly there is this magic formula that everyone heals within a 4-8 week time frame. If it was that easy, why would anyone ever have to treat? It isn’t that simple, that’s why. Each accident is different. Each person and their injuries are different. There is no magic formula to how or when someone is going to heal, or if they will ever even completely heal. That’s why it is important to have someone who is fighting for you, attorneys who fight insurance companies on a daily basis to protect their clients from insurance companies taking advantage of their insureds.
I am an attorney who fights insurance companies and represents people who have been injured in an accident. If you have been injured, I would be happy to speak to you about your case. All initial consults are free of charge, and if I am able to take on your case, I charge on a contingency fee basis (meaning I don’t get paid unless we win). Call our Personal Injury Team at 701-297-2890 or send us an email below.