The PIP “Independent” Medical Examination

What is an Independent Medical Examination (“IME”)?

Your auto insurance policy has a provision which allows the insurance company to have a physician perform a medical examination to determine if any further treatment is necessary.  A more accurate name would be, “Insurance Medical Examination” since the insurance company pays the doctor/chiropractor.  The IME physician is “working” for the insurance company and therefore no doctor/patient confidentiality exists.  You are required to attend an IME based on the contractual obligations of your insurance policy.
The insurance company almost always unilaterally schedules these examinations before your treating physician has completed your course of treatment.  In the vast majority of cases your benefits will be suspended after you attend this examination as the IME physician will determine that further medical treatment is not warranted.  Remember, the IME physician is paid by the insurance company.  Once the IME physician determines (after a single visit) that you don’t need any further treatment, the insurance company will no longer pay benefits to your treating physician.

It is, however, extremely important that you do not miss the appointment otherwise the insurance company will automatically suspend and/or deny your benefits for lack of cooperation.  Our firm, in almost every case, requires the insurance company to schedule the IME at a time convenient to our clients with plenty of notice and coordination of the date and time.  We also require the insurance company to provide transportation when necessary.

Once you are at the doctor’s office they will ask you to fill out a form stating your injuries, course of treatment, medications, etc.  Try to be as accurate as you possibly can.  Do not discuss how the accident happened, how much property damage occurred, or who was at fault with the IME doctor.  The IME doctor is not your friend.  He/she will report everything you tell them to the insurance company and even innocent conversation will be taken out of context and embellished by the IME physician.
When the IME doctor authors a report stating that your treatment is no longer necessary, your PIP benefits will be suspended effective immediately.  However your treating physician can challenge the IME doctor’s opinion in an effort to reestablish your benefits.

We often are involved in situations where the treating doctor believes further treatment is warranted after the IME physician determines it is not.  Just because the insurance company says you don’t need medical care does not make it true.

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