Independent Medical Exams
One trick that is important to be aware of is how adjusters can use an independent medical exam (IME) as an excuse to deny your injury claims.
An independent medical examiner is a doctor who has not been involved in a patient’s treatment and care, and is chosen by the insurance company. It’s kind of like a second opinion for the insurance industry.
Although every case is different, it’s generally not good if an accident victim has to see an IME. It usually means that the insurance company thinks the injured person is over-treating or is not really hurt or is not as seriously injured as they say. If a PIP independent medical examiner finds that the injured person has recovered, the insurance company stops paying the medical bills, and then you either have to pay for the medical treatment yourself or stop seeking treatment.
An IME, or independent medical exam, is performed by a doctor who has never previously treated the patient (or plaintiff) involved in a person injury case. According to ORCP 44: “When the physical condition … of a … person … is in controversy, the court may order the party to submit to a physical … examination by a physician … The order may be made only on motion for good cause shown and upon notice to the person to be examined and to all parties and shall specify the time, place, manner, conditions, and scope of the examination and the person or persons by whom it is to be made.”
In English, that means that “independent” medical exam can be used to determine if a patient is as hurt as he or she says. So an “independent” examiner is brought in for a kind of second opinion, if you will.
But there’s a big problem with independent medical examiners: They’re not really very independent at all. In fact, a lot of these “independent” medical examiners are quite dependent on the defense teams and insurance companies- and vice versa. As personal injury lawyers, we like to call this a DME, for “defense medical exam”, because it’s the defense that requests them, and it’s the defense that benefits from them.
Although the doctors will not have worked with the patient before, they have almost certainly worked with the defense or insurance company, and will probably work with them again. The defense chooses the doctor and pays for the doctor. And that doctor often makes a decent amount of his or her income from the “independent” medical exams.
In general, the defense requests and IME with the hope that the doctor will come back with a diagnosis much more in line with what the defense wants to be said. And the doctors almost always do. What that usually boils down to is doctors performing short, poor exams, and then writing up a report that helps the defense, and hurts you.
It’s important to know that IMEs can only be ordered by the court. If a defense wants an IME, it’s only a request. Second, the defense must show “good cause,” or a reason for the exam other than “I don’t want to lose my case, so I’m bringing in another doctor who might take my side.” Often, the defense believes it’s their “right” to an IME, but they are sadly mistaken.