When you hear the term "Independent Medical Exam", you might envision a fair and thorough medical evaluation. However, the reality of an IME might not fully match that expectation. An IME is a medical evaluation often required in legal cases or insurance claims, yet it's typically conducted by a doctor hired by an insurance company.
What’s the Purpose of an IME?
The primary goal of an IME is to provide the hiring party (usually an insurance company) with an “independent” assessment of a claimant's medical condition. Instead of giving medical advice or treatment, IMEs are focused on evaluating the validity of a person’s claim. While they're meant to help make decisions on things like causation, disability, or continued treatment, IMEs have drawn criticism for biases against injured or sick workers’ benefits.
An IME is supposed to help determine the extent of disability and whether ongoing medical treatment is necessary. Yet, because IME doctors rely on the same insurance carriers for future business, their assessments don’t always align with the patient's regular physician. This in turn leads to disputes over the necessity of treatments or the degree of an injured person’s disability.
How is an Independent Medical Exam Performed?
An IME isn’t quite what you'd expect from a standard medical examination. Usually, it’s incredibly brief and lacks the thoroughness of a regular medical visit with your treating doctor.
Here's what generally happens in an IME: At the start of the visit, the injured person will complete a detailed medical history form. Once completed, the IME doctor reviews the form and any medical records provided to get an overview of the person’s medical history related to the visit.
Once that’s complete, a short medical examination ensues, during which the IME may ask questions about symptoms, previous treatments, and any changes in your condition. At this point, there may be a brief, limited physical examination performed of the injured body parts.
The entire IME process could last only 5–15 minutes. It’s not uncommon for people who undergo an IME to feel like it wasn’t thorough and unrepresentative of what their true condition is.
How is an IME Different from a Regular Medical Exam?
How does an IME stack up against a standard medical examination? Primarily, an IME is far less detailed. Standard medical exams conducted by a patient's regular doctor typically involve a thorough evaluation of the patient's health history and present condition, focusing on accurate diagnosis and effective treatment plans. In contrast, the IME aims to assess the need for compensation and continuation of treatment from the financial perspective of the insurance company.
Due to the less comprehensive nature of IMEs, discrepancies can occur. For cases like workers' compensation, these discrepancies often lean toward lesser degrees of disability than those diagnosed by the treating physicians. Because of this, claimants might find themselves having their benefits reduced, based solely on an IME's findings.
How Does an IME Impact New York No-Fault Lost Wage Benefits?
No-Fault insurance companies will often blindly make decisions surrounding wage-replacement benefits for injured workers. When an IME doctor assesses a person’s injury as a mild partial disability, for instance, the worker might face a drastic reduction in their compensation. Imagine a person who, under the supervision of their treating doctor, is receiving a weekly benefit because they were unable to work due to their injury. An IME's contrasting report could heavily cut down on these benefits, pushing the injured worker into a financially unstable situation until further proceedings take place.
How Does an IME Impact New York No-Fault Medical Benefits?
Insurance carriers rely heavily on IMEs not just for deciding wage-replacement benefits but also for evaluating the need for continued medical treatment. If an IME report contradicts the treating doctor's recommendations, medical treatment prescribed for recovery might be discontinued. This can lead to major consequences for an individual's healing process, possibly leading to lingering or aggravated injuries. The potential refusal or delay in recommended treatments can influence whether an injury remains a temporary setback or progresses to a permanent disability.
Use in Fraud Prevention
Beyond evaluating medical conditions and payment benefits, IMEs are used as a tool to prevent fraud. Insurance companies use IMEs to scrutinize the validity of injury claims. By conducting these examinations, they aim to ensure that only justified claims are paid. While this intent is to eliminate unjustified claims, the IMEs themselves more often than not negatively impact people who have legitimate needs.
Independent Medical Exams play a big role in the handling of No-Fault benefit claims and personal injury claims. While aimed at maintaining a fair process for evaluating insurance claims, IMEs often disproportionately affect legitimately injured accident victims to the benefit of insurance companies.