Q. For those who may not know, please explain what an IME is all about.
A. If you become disabled or injured, one of the things the insurance carrier may demand is that you submit to an Independent Medical Examination, or IME. Most people assume that this medical examination is impartial because the word independent is used in the title. However, that could not be further from the truth. In fact, it would be a lot more accurate to call the exam an Insurance Medical Exam because it is done by, for, and to benefit the insurance company. Unfortunately, insurance carriers are not looking for an independent evaluation.
Q. Who chooses the examining doctors, and who do these doctors work for?
A. Most medical professionals who perform IME’s work for insurance carriers on a regular basis either in a direct relationship with the carrier or with a third-party IME service. This gives them a vested interest in finding disabled or injured claimants healthy and able-bodied – they consider it job security. These medical professionals seek to tell the insurance carriers (their customers) what the insurance carriers want to hear, i.e., that the patient is medically fine and not entitled to disability benefits. They know that if they perform a real independent examination and find the claimant to be disabled or injured, it will lead to less repeat business from the insurance carrier, or carriers. In the end, the IME doctor most often chooses to keep his or her customer happy by giving them what they want – a medical report which supports denying the claim.
Q. What can a client expect during an IME?
A. It usually starts with a record review. Before you have even met the IME doctor, the insurance company already has combed through your medical records, typically cherry-picking which records to provide to the IME doctor for review. The records are often taken out of context to make it seem as if the claimant’s medical condition isn’t too bad, or that the medical evidence is contradictory or ambiguous. As a result, even if the IME doctor may be inclined towards impartiality, he or she only is provided with controlled information.
Another fairly common practice among some IME doctors is to look for “holes” in your medical record. Something as simple as an accidental omission on the part of your treating physician can result in an IME report that says your medical report does not support your disability or personal injury claim.
The carrier also provides the IME doctor with specific written questions for him or her to answer. And finally, when the exam finally happens, it usually is quite superficial. Most IME’s only last a few minutes – surprising given the length of the IME doctor’s report and the extensive list of clinical testing the doctor supposedly performed.
Q. What other kinds of problems can a client expect from an IME?
A. Added to this already unfair system is the fact that many of these IME professionals often have their own preconceptions and biases about the medical conditions the claimants have. Many IME doctors will dismiss – outright – debilitating illnesses and conditions such as chronic fatigue syndrome and fibromyalgia because these conditions are not easily detectible through CT-scans, MRI’s, or other diagnostic testing. Unlike a treating physician (your doctor) who tends to examine and treat you over an extended period of time, IME doctors see only a snap shot of your medical condition. The most an IME doctor can do is comment on the claimant’s condition on the one occasion that he or she performs the examination on behalf of the insurance carrier.
Q. What happens if you don’t go to the IME exam?
A. You cannot refuse to go to an IME. If you do, there is a high probability that the insurance carrier will deny your claim or cancel your benefits. But, you can be prepared by retaining a knowledgeable attorney at the outset. Our firm, for example, counsels our clients before they go to their IME’s. And, we send a registered nurse from our staff with them to the examinations. That serves two purposes: 1) it tends to relax our clients, and 2) it sends a message to the independent medical professional performing the exam that the client’s law firm is paying attention.
