Here's How Insurance Companies Use IMEs to Their Advantage

Navigating the world of insurance claims can be complex, particularly when it involves an independent medical examination, often shortened to IME. Insurance companies often require these examinations as part of the claims process, which can leave claimants feeling unsure and concerned about their rights.

Have you been asked to undergo an independent medical examination? Let’s talk about your rights and options. Call Peake & Fowler at 803-788-4370.

What is an Independent Medical Examination?

An independent medical examination is an assessment conducted by a doctor who is not involved in your regular medical care. Insurance companies often request these exams to get an impartial opinion about your injury or illness. The purpose is to provide an objective evaluation of your medical condition, separate from the opinions of your primary healthcare providers.

The doctor conducting the IME will review your medical history, perform a physical examination, and run diagnostic tests to determine the extent of your condition. This evaluation can significantly impact your insurance claim, as the findings may influence decisions on your claim’s validity and the amount of compensation you receive. Understanding what an IME entails can help you prepare for the process and protect your rights.

The Role of IMEs in Insurance Claims

Insurance companies rely heavily on the findings from independent medical examinations when processing personal injury claims. These examinations are used to assess the legitimacy and severity of a claimant’s medical condition. The results can determine whether a claim is approved or denied, and they also influence the amount of compensation offered.

Although IMEs are presented as neutral evaluations, they can sometimes be used to minimize payouts. For instance, if the doctor conducting the IME downplays the severity of your injury, the insurance company might use this information to offer a lower settlement. Understanding the role of IMEs in your claim can help you better prepare and protect your interests during the process.

Potential Bias in Independent Medical Examinations

Although IMEs are supposed to be impartial, they can sometimes be biased. The insurance company is the one who selects and pays the doctor conducting the examination, which can lead to a conflict of interest. This financial relationship might influence the doctor, even unintentionally, to provide findings that favor the insurer.

For example, the doctor might downplay the severity of your injury or suggest that your condition is not as serious as you claim. These biased reports can significantly affect your insurance claim, potentially leading to reduced compensation or even denial of your claim. Being aware of this possibility can help you better prepare for your IME and take steps to ensure that your condition is accurately represented.

What to Expect During an Independent Medical Examination

During an independent medical examination, you will meet with a doctor chosen by the insurance company. This doctor will start by reviewing your medical history, so be prepared to provide detailed information about your past treatments, surgeries, and medications. The doctor will then perform a physical examination to assess your current condition. This might include checking your range of motion, strength, and any specific areas related to your injury or illness. In some cases, the doctor may order additional tests, like X-rays or MRIs, to get a clearer picture of your condition.

Throughout the independent medical examination, the doctor will be observing you closely. It’s important to be honest and accurate when answering questions about your symptoms and daily limitations. Avoid exaggerating your pain or downplaying your condition, as this can affect the credibility of your claim. The doctor will compile their findings into a report, which will be sent to the insurance company. This report can have a significant impact on your claim, so being well-prepared and truthful during the IME is essential.

Remember to stay calm and composed during the examination. You have the right to request a copy of the report from the independent medical examination and review it for accuracy once it’s completed.

How to Protect Your Rights During an Independent Medical Examination

To protect your rights during an IME, start by being well-prepared. Gather all relevant medical documents, including records of past treatments, surgeries, and medications. Having these on hand will ensure you provide accurate information during the independent medical examination. It’s also a good idea to write down your symptoms and how they affect your daily life. This can help you remember important details when speaking to the IME doctor. Keep your own notes about the examination, including what tests were done and what questions were asked.

Start Your Personal Injury Claim Today

The earlier you reach out to the team at Peake & Fowler, the sooner we can begin fighting for you, against unethical practices and independent medical examinations that may affect your recovery. Set up a consultation right away by filling out our contact form or calling us at 803-788-4370.