When you bring a personal injury claim or file a personal injury lawsuit, you might be required to have something called an "independent medical examination" (IME). But don't be fooled: An IME isn't independent, and chances are it won't be like any medical exam you've had before. The IME doctor isn't interested in helping you or your case.
You should prepare for your IME. We'll give you some tips on how to be ready and things you can do during and after the IME to protect your rights.
After reading this article, you'll better understand:
(The rules we discuss here generally apply to personal injury claims. If you have to attend an IME for a workers' compensation claim or a disability claim, different rules might apply.)
First things first. An "IME" should be called what it is: A defense medical exam. The insurance company or its lawyer wants you to have a medical examination by a doctor of the company's choosing. Why? The purpose of the IME is simple: To help the insurance company defend (meaning deny, or pay as little as possible for) your personal injury claim.
The insurance company will set up and should pay for the IME, which will happen at the examining doctor's office. Here are some things about an IME you should know:
Above all else, understand this: The IME doctor is the insurance company's doctor, not yours. The insurance company probably has an ongoing relationship with the doctor. It knows the doctor will write an exam report that helps the company and hurts you. That's what the doctor is being paid to do.
Here are a couple of other things to keep in mind.
The IME doctor is entitled to review the medical records related to your personal injury claim. Most often, the insurance company or its lawyer will ask you to sign a release authorizing them to get your records. Here are some pointers:
The insurance company typically wants the IME doctor to go on a fishing expedition through your health history in search of ways to pay less for your claim. Expect the other side to argue with you over how many past years' records they're entitled to get.
If the insurance company or its lawyer wants to fight over your medical records, you should get advice from an experienced lawyer.
Your state law and—if you've filed a lawsuit—the court's "rules of civil procedure" (rules that govern civil lawsuits) might have more to say about your IME. Here are some things to look for:
You can be required to have an IME in a couple of different circumstances:
You might have to undergo an IME when you bring a claim for benefits under your own car insurance policy (sometimes called a "first-party claim"). For example, suppose you were hurt by an uninsured driver and you're claiming uninsured motorist benefits under your policy. Your insurance company might ask that you go for an IME.
Your auto policy likely requires that you attend an IME at the insurance company's request and expense. If you refuse, you've violated (in legal terms, "breached") your insurance contract, giving the insurer grounds to deny your claim.
When you file a lawsuit to collect damages from someone who caused you injuries (sometimes called a "third-party claim") or to collect benefits for your first-party claim, you're required to participate in a process called "discovery." During discovery, the insurance company's lawyer might ask you to have an IME.
In most states, the rules of civil procedure spell out when you can be required to attend an IME. If you refuse to have an IME that's required by the rules, the court can penalize you. (To get help finding or understanding the court rules, consult with an experienced personal injury lawyer.)
In most cases, the insurance company or its lawyer will try to use an IME for any of three purposes:
The doctor will be looking for evidence that you weren't injured, or if you were injured, that your injuries are nowhere near as painful or disabling as you claim. For example, if you claim a low back injury, the doctor might ask you to do walking or leg-lifting tests that are designed to reproduce low back injury pain. If you don't respond as expected, the doctor could claim you're faking or exaggerating your injuries.
If the doctor can't prove that you weren't hurt, the next best thing is to show that your injury was caused by something that gets the insurance company off the hook. In legal terms, the doctor is looking to defeat "causation."
Let's return to our low-back injury example. Does your medical history include low back problems? Do you play golf, run, or lift weights? Do you work at a job that requires repetitive bending, stooping, lifting, or carrying? The doctor could point to things like these as proof that your injury was caused by something that doesn't require the insurer to pay.
If the doctor can't defeat injury or causation, what's left is to discredit you—to make you look like a liar, or someone who's just looking to avoid work, or a claimant who wants to cash in on a nonexistent or minor injury.
For example, the doctor's report might point to inconsistencies between what you reported during the IME and what you told a treating doctor. The doctor might report that you walked, stood, and sat normally while in the waiting room but then limped or complained of pain or limitations during the exam. If it makes you look bad, expect it to show up in the IME report.
Ideally, you'll prepare for an IME with a personal injury lawyer who can help you know what to expect. For example, an experienced lawyer can do role-playing exercises with you, playing the part of the doctor and asking you questions. After each session, the lawyer can explain where you did well and where you need to improve. The lawyer can also give you some ideas about what tests or exercises the doctor might ask you to perform.
At a minimum, to prepare for your IME you should get a complete copy of all the medical records you provided to the other side and you should review them carefully. Among other things, the doctor will be looking for inconsistencies between what you report during the exam and what's recorded in your records. You want to be as consistent as possible.
You'll want to refresh your memory about past injuries and conditions that appear in your medical history so you can be prepared to answer questions about them. If you're surprised by things that come up during the exam, you're more likely to give answers or explanations that hurt your claim.
Finally, if you've given any prior statements about your injury, how it happened, your treatment, or your recovery, review copies of those statements, too. Chances are the insurance company has given copies of your statements to the IME doctor.
Let's begin with what not to expect during your IME. Don't expect a complete medical exam like you'd get from a treating doctor. The IME isn't really about your overall health.
In addition, don't expect the doctor to discuss or explain to you their findings once the exam is finished. The doctor will prepare a written exam report and send it to the insurance company or the company's lawyer. You'll get a copy of the report from them.
The specifics will vary from one examiner to the next, and some of the questioning might be done by a member of the doctor's staff. In general, you should expect to be asked about some or all of these topics:
Chances are the IME doctor will do some kind of physical examination, but don't be surprised if it's remarkably brief. The purpose of the physical examination isn't to determine the state of your health. It's to look for evidence that you aren't really injured, that your symptoms aren't the insurance company's responsibility, or to discredit you.
While you should be courteous and professional (even if the doctor isn't), don't be chatty, try to make small talk, or volunteer information. Answer all the doctor's questions completely and truthfully, then stop talking. Don't offer explanations unless you're asked. If you're asked to explain something, keep it short, truthful, and to the point.
The IME isn't your chance to tell your side of the story. That opportunity will come at another time. If you're in doubt about whether you should say or do something during the IME, keep this in mind: Nothing you say or do in the IME will win your case, but you might say or do something to lose it (or decrease its value).
Once the IME is finished, there's probably more to be done. Ideally, once again, you're working with an experienced personal injury lawyer who will know what steps to take to protect your rights. Here are a few things to consider.
Write down everything you can recall about what the doctor and the doctor's staff said and did while you were in the office. Note how long you were questioned, as well as any topics that were emphasized during the questioning. Make a note of how long the doctor's physical exam lasted, what the doctor did, what you were asked to do, and anything the doctor might have said during the exam.
Make notes about any errors in the IME report. If the report includes medical statements or conclusions that differ from what your treating doctors have said, be sure to highlight those differences. You (or your lawyer) can raise these errors when trying to negotiate a settlement of your claim.
If you've filed a lawsuit, you can probably use your notes to refresh your memory if you have to testify in a deposition or at trial. But the court rules will require that you provide a copy of your notes to the insurance company's lawyer. Be sure your notes are truthful, factual, and accurate.
You want to find out about the IME doctor's relationship with the insurance company and its lawyers. You also want to know how much time the doctor spends, and how much money the doctor earns, doing IMEs as compared to doing actual patient care.
If you've filed a lawsuit, your lawyer (if you have one) will ask about these things during discovery. If you're handling the case on your own, you should send the other side interrogatories (written questions that must be answered under oath and in writing) asking:
Your lawyer might advise you to ask your treating doctor to review the IME report for medical accuracy. If your doctor identifies problems with the report, set up a phone call so you (or better yet, your lawyer) can discuss them. If your doctor's concerns are significant, consider asking the doctor to write a letter describing the problems and inaccuracies.
Note that if you've filed a lawsuit, you might have to let the other side know that your treating doctor disagrees with the IME doctor's report.
If the IME report is particularly bad and the insurance company or its lawyer is relying on it to make a low settlement offer, give some thought to hiring an independent, non-treating doctor of your own to examine you and write a report. You'll want an examining doctor who's familiar with how IME doctors work, and who understands how to write a report that can counter the harm a bad IME report can do.
Before taking this step, you should consult with an experienced personal injury lawyer.
An IME can be a crucial part of your personal injury claim or lawsuit. The purpose of an IME is to give the insurance company reasons to deny your claim, reduce the amount the insurer pays you to settle, or convince a jury to decide against you. There's a lot at stake—far too much to go it alone.
You need an experienced personal injury lawyer to help you prepare for the IME, guide you through the process, and do damage control once the IME doctor issues a report. You're not just up against the insurance company's doctor—you're up against its lawyers, too.
Here's how to find an experienced personal injury lawyer who's right for you and your case.