Why Do Insurers Request Independent Medical Exams

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The request for an IME is, unfortunately, a very common tactic used by insurance companies to challenge the validity and extent of your injuries following an accident. While they present it as a neutral assessment, it’s critical to understand that these exams are almost always conducted by doctors hired by the insurance company, creating an inherent bias. The IME doctor’s role is to find reasons to dispute your treating physician’s findings, often downplaying the severity of your injuries and questioning the need for ongoing care.

They’re looking for ways to deny, delay, or devalue your claim, and an IME is a primary tool in that effort. Insurance companies aren’t necessarily looking for the truth; they are looking to protect their bottom line. This is why it’s absolutely essential to have experienced legal counsel before agreeing to any IME.

I’ve been practicing personal injury law in San Diego for over 13 years, and I’ve seen this scenario play out countless times. Trained by a former insurance defense attorney, I possess intimate knowledge of how insurance companies evaluate, devalue, and deny claims. I understand precisely what they’re looking for in an IME, and how to prepare you to navigate this often stressful and intimidating process.

What should I expect during an Independent Medical Examination?

An IME is different than a routine check-up with your doctor. The doctor conducting the exam is not your physician and does not have your best interests at heart. You should expect a very focused and, potentially, aggressive examination. They may try to catch you doing something that contradicts your reported limitations, like asking you to lift heavy objects if you’ve claimed a back injury. Be prepared for them to scrutinize your medical history and question your pain levels.

The IME doctor will typically review your medical records, conduct a physical examination, and request your medical history. They may also ask about your activities of daily living and your employment history. It’s crucial to be honest, but also concise and focused in your answers. Avoid volunteering information that isn’t specifically asked for, and do not exaggerate your symptoms. Your responses will be meticulously documented and used to potentially challenge your claim.

It’s important to remember that the IME doctor is paid by the insurance company, and their report will likely reflect that. They may minimize the impact of the accident, question the necessity of your treatment, or even suggest that your injuries are pre-existing or unrelated to the collision.

Can I refuse to attend an Independent Medical Examination?

In California, refusing an IME can have serious consequences for your claim. The insurance company may deny your benefits or even seek a court order to compel you to attend. However, you don’t have to blindly accept their request. We can challenge the legitimacy of the examination, such as questioning the doctor’s qualifications or the scope of the review.

Under California law, the defense is entitled to one physical examination of the plaintiff if the lawsuit seeks damages for personal injuries. While often called ‘Independent,’ these doctors are hired by the insurance company to challenge the extent of your medical claims (CCP § 2032.220). We can also ensure the examination is conducted fairly and that your rights are protected.

As your advocate, I’ll work to ensure the IME process is handled appropriately and that your rights are preserved. This includes preparing you for the examination, attending with you if necessary, and thoroughly reviewing the IME report for inaccuracies or biases.

What happens after the Independent Medical Examination?

After the IME, the doctor will prepare a report detailing their findings and conclusions. This report will be sent to the insurance company, who will then use it to evaluate your claim. Unfortunately, IME reports often contain subjective opinions and can be biased against the plaintiff. It’s crucial to have an attorney review the report and challenge any inaccuracies or misrepresentations.

We can work to obtain your complete medical records and compare them to the IME report, identifying any discrepancies or omissions. We can also consult with your treating physician to obtain a rebuttal report, explaining why the IME doctor’s conclusions are flawed or unsupported by the medical evidence.

Fighting an unfavorable IME report requires a thorough understanding of medical terminology, legal procedures, and insurance tactics. Having a skilled attorney by your side can significantly increase your chances of a fair settlement.

Should I tell the IME doctor about all my pain?

This is a tricky question and the answer is – it depends. While honesty is important, you don’t want to exaggerate your symptoms or volunteer information that isn’t specifically asked for. You should accurately describe your pain levels and limitations, but avoid providing details about pain that you haven’t discussed with your treating physician.

Remember, the IME doctor is not your advocate. They are hired by the insurance company to gather information that supports their position. They may try to trick you into admitting something that contradicts your previous statements or diminishes the severity of your injuries. It’s crucial to remain calm, concise, and focused in your responses.

I will work with you to prepare a detailed statement outlining your symptoms and limitations, ensuring you present a consistent and accurate picture of your condition. We’ll also discuss strategies for responding to potentially leading or aggressive questions during the examination.

What if the IME doctor disagrees with my treating physician?

It’s common for IME doctors to disagree with the opinions of your treating physician. This doesn’t necessarily mean your claim is doomed. However, it does mean you’ll need to vigorously defend your position and present compelling evidence to support your case. This could include additional medical records, expert testimony, and witness statements.

We can challenge the IME doctor’s qualifications, methodology, and conclusions. We can also demonstrate that your treating physician has a long-standing relationship with you and a thorough understanding of your medical history. The goal is to convince the insurance company – or a jury – that your treating physician’s opinions are more credible and reliable.

Successfully navigating a disagreement between doctors requires a comprehensive understanding of medical-legal principles and a strategic approach to evidence presentation. I’ll work tirelessly to protect your rights and ensure you receive the compensation you deserve.