Why is My Insurance Company Sending Me to an Independent Medical Exam?

By March 12, 2014 Uncategorized No Comments

The Problem with the “Independent Medical Exams (IME’s)”

Independent Medical Examiners (IME’s) work for the insurance company, not for you. Here’s how it works, and why you shouldn’t trust an IME.

All car insurance policies issued for delivery in Oregon must contain a minimum of $15,000 in Personal Injury Protection benefits, or PIP. When you get into a car accident in Oregon your own car insurance is the primary insurer for your medical bills regardless of who was at fault in the accident.

For example, if you get rear-ended in a car accident and need medical care, your own insurance pays for your medical bills even if the other driver was at fault. If the other driver is injured in the same collision, his own insurance pays for his medical treatments.

So where do independent medical exams come in?

Using Independent Medical Examiners to Limit Payments

Consider the following example: you were injured in a car accident in Oregon and need medical care. Your car insurance should accept coverage and pay all medical bills that are reasonable and necessary as a result of the collision. However, after six months, you are still not fully recovered.

In many situations like this your insurance carrier will send you to what they call an Independent Medical Exam (IME). I say that “they” call it that because it’s definitely not independent. I would argue that it’s also not medical, but I’ll let them call it an exam.

Independent Medical Exams Cost Oregonians

These IMEs are a huge problem in Oregon. In a significant majority of cases I know what the doctor will say before you ever go in to be examined. The insurance companies usually hire doctors that will claim that you are no longer injured.  I’ve seen scenarios so egregious that it would make your skin crawl.

I had one case where my client was scheduled to undergo a two-level lumbar fusion at a cost of approximately $140,000. He had exhausted his medical benefits under his PIP policy, but he still had wage loss benefits available to him. His PIP carrier scheduled him for an IME, and I sent over the written opinion of the surgeon that my client needed back surgery. To no one’s surprise, the IME doctor found that my client was not even injured and could return to work full time. It should also be noted that my client worked in the construction industry so returning to work was no simple task.

If Your Insurer Sends You to an Independent Medical Exam Call an Attorney

We file a lot of lawsuits against PIP carriers to counter this practice. It hasn’t stopped any carriers from doing this or changed their strategies, but we have had considerable success getting payment of the denied benefits.

Again, this is a huge problem in Oregon. If you are scheduled for an IME, contact an attorney immediately to discuss your rights. Different attorneys have different views on how to proceed. Some will tell you not to go to the IME. Some will tell you to go but be prepared to file a lawsuit at a later date to recover the unpaid benefits. You need to find an attorney who will stand up to your insurance company to the end.

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