We see many patients with car accident injuries at Berkower Pain and Spine Rehabilitation, as well as workplace and other injuries that may involve insurance companies. A third-party insurance company, or even your own insurer, could dispute the severity of your injuries as part of their claims process. They may request an independent medical exam, or IME, to verify your condition and how it affects your daily life.
Though IMEs are intended to be impartial, a way to detect insurance fraud, sometimes it doesn’t feel that way to you as a patient. Since the physician is usually chosen by the insurance company, it makes sense that they will approach an IME with the insurer’s perspective in mind.
Understanding what to expect from an IME may help you navigate the process better, so we’ve prepared this summary for you. It may not prevent you from an exam with a hostile physician, but you’ll have a better idea how your exam should progress. These five tips may help you cope with the sometimes intense sessions.
Perhaps the biggest difference between a normal physical exam and an IME is the length of time involved. If you’re used to feeling rushed through a doctor’s visit, you may be surprised to find out your IME may last for hours. It’s in the best interests of the investigating insurance company to be thorough, since often large payouts are at stake.
Unless instructed otherwise, have a meal prior to your IME, and arrange to have other aspects of your day covered, things such as childcare arrangements or time away from work. Dress casually in comfortable clothing. Some clinics may offer refreshments, but this isn’t universal. Bring your own snacks if you think this might be necessary for your comfort.
Even if you have provided a completed questionnaire, the IME physician will ask you about your medical history, circumstances surrounding your injury, the symptoms you experience, and the treatments you’ve received for these. The doctor is probably looking for signs of injury that pre-dated the incident that caused your current medical issues. Proof of a pre-existing condition could void insurance coverage.
As well as your physical condition, the doctor will be assessing your nature, trying to determine if you’re credible and sincere. They may try to trick you using various techniques, such as asking similar questions repeatedly. Your perceived honesty will be part of their report.
The physical exam will probably be familiar, including vital signs such as blood pressure, chest exam, and ears, nose, and throat. After this, focus will move to the injured areas. This will likely include tests for mobility and range of motion. The doctor is looking for signs that your physical condition corresponds with the extent and symptoms of the injury as you described through the interview. Additional testing may be ordered at this point, to be conducted now or later.
The results of the IME are summarized in a report between the doctor and insurance company. The doctor gives his opinion as to the extent of your injuries and how much they should affect your daily life. Expect that this report may downplay how much these issues should affect you. If you disagree with the results of the IME, you may have the right to have another examination with your choice of doctor.
In many cases, it’s a good idea to consult with a lawyer familiar with the IME process prior to your exam to further familiarize yourself with the process. Knowing the extent of your rights helps your confidence through your IME visit and acceptance of results.