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Independent Medical Examinations

October 14, 2010

By: Eric Steinberg

Independent medical examinations, also known as “IMEs”, are common throughout the state of Michigan in personal injury cases.

However, they are extremely common in Michigan automobile no-fault cases. In theory, an independent medical examination is when a physician, who has not previously been involved in the person’s care or treatment, examines a patient and gives an unbiased and fair opinion as to the cause and extent of the patient’s injuries, as well as the patient’s prognosis for recovery. This opinion is then used by the insurance company to confirm or refute the opinions of the patient’s treating physicians.

The problem is in reality, this is far from the case. In reality, the IME is an opinion bought and paid for by the insurance company to “cut-off” a claimant from access to further no-fault benefits. Often, this leaves the claimant without any means to treat for his or her injuries, especially in those cases where the claimant has no health insurance and auto or worker’s compensation insurance was paying for medical care.

The IME scam is very simple. The insurance company will select a doctor from its pre-approved vendor list, hiring the doctor through an independent medical examination company or “IME mill”. These doctors are actually independent contractors working for the IME mill. Many of the same doctors work for multiple IME mills, spending most of their work days conducting these bogus exams. Through various discovery efforts, I have been able to discover that many of these physicians earn more than $250,000 per year performing IMEs. Some earn much more each year!

As you can imagine, performing multiple “evaluations” leaves little time to actually practice medicine on see real patients. So many of these hired guns actually have no active medical practice or patients to speak of. Amazing!

Once the insurance company selects a doctor, an appointment is set-up (usually without first asking if the patient is available that day) and the patient is forced to undergo the evaluation. In Michigan no-fault automobile cases, it is extremely difficult, if not impossible to prevent the evaluation from taking place. After the evaluation is performed, and these exams are sometimes as short as 5 minutes, the IME doctor will draft a report and the IME mill will send it to the insurance company along with an invoice. The charges for these exams are outrageous, sometimes costing more than $1,000. The insurance company will then use this report to make a decision on whether it will continue to extend benefits to the injured person.

More often than not (in my experience more than 90% of the time), the hired gun will formulate a report that says either (1) the patient’s injuries are not related to the car accident and/or (2) the patient’s injuries have fully healed and he or she can go back to their jobs or every day life without any restrictions. The insurance company will use the report to terminate some form of benefits to the injured person, whether it is further medical treatment, wage loss benefits or other no-fault benefits like replacement services and attendant care.
Oftentimes, these bribed opinions will be used to retroactively terminate medical benefits, leaving the injured patient with substantial medical bills.

Of course, the IME doctor has an incentive to write a report explaining the patient wasn’t hurt in the car accident or is now fully recovered. Money. If the doctor writes too many reports that favor the injured person, that doctor will not be used again for future evaluations by the insurance company.

What’s all the more appalling is when rendering their own opinions, IME doctors and the insurance companies will completely ignore the opinions of treating physicians, doctors who have examined the patient many times over a longer period of time. Who is going to have a better understanding of a patient’s care and recovery, some hired gun who was paid $1,000 to do an exam for 5 minutes, or a treating doctor who has physically examined and cared for the patient numerous times over a span of many months and years? Well, it doesn’t take a rocket scientist to figure this out now does it.

The IME system is a mess and needs reform. Unfortunately, the present system appears to be here to stay and in anything, is only getting worse.

The following are some helpful tips though if you are a loved one is asked to undergo an independent medical exam:

1. Write down when the exam starts and when it ends. You’ll be shocked and it can be used later when your lawyer later takes the doctor’s deposition.

2. Never fill out the “patient registration form” or “consent form” given to you by the “nurse” at the front desk upon check-in. They will be used against you later by the insurance company and their lawyers.

3. Never talk to the doctor about how the accident occurred. He will only use your summary to bend the facts in the report to benefit his client, the insurance company.

4. Only submit to objective testing, such as x-rays, if your attorney allows it.

5. Don’t exaggerate your symptoms or pain during the exam.

6. Be aware that the insurance company may be conducting surveillance on you in the parking lot outside of the examination office.

7. Dress appropriately.

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