A common trick insurance companies use to stop paying on medical no-fault PIP claims is to send the claimant to an “independent” medical examination. This examination, more commonly known as an IME, is no real medical examination. Instead a claimant is sent to an IME mill where he or she will visit with a cut-off doctor for a short examination. Often these examinations are no longer than 10 to 15 minutes. The cut-off doctor is paid by the insurance company to author a report. This report, almost always without fail, recommends the insurance company to stop paying future medical benefits to the claimant.
Various excuse are given for ceasing further payment of auto accident related medical treatment. Sometimes the doctor will say the patient has reached MMI, or maximum medical improvement. Other times the doctor will say the patient is not that injured and further medical treatment, whether it is physical therapy or steroid injection therapy, is unwarranted and not needed.
Whatever the excuse is, the result is always the same. The patient is left with no further means to obtain much needed medical treatment because the auto insurance company refuses to pay for further care.
This old game is nothing new. Car insurance companies such as State Farm and Allstate have been masters at this game for years and years. What is new is how early these examinations are now occurring and how claimants are forced to see multiple cut-off doctors in varying specialties, even after they have already been cut-off by another doctor earlier.
For example, I have one client who was involved in a case accident in December. Sometimes in late January the insurance adjuster handling the medical claim for my client wanted to send my client for an “independent medical examination” – presumably to stop treatment before it ever really could get going. Unfortunately, there is little I can do to prevent this examination. The Michigan Supreme Court has held insurance companies can order these exams at will with little recourse for the claimant to prevent them from occurring. Either show up for the examination, or risk having your claim thrown out.
However, on this occasion, this particular adjuster didn’t just want one exam. Instead she wanted three separate examinations, one with a pain doctor, another with a chiropractor, and still another with a neuropsychologist to check to see “if my client actually had a closed head injury.”
I could tell by the adjuster’s voice and tone that she didn’t think my client was injured in this car accident. She believed this despite the fact the police report indicated my client, who was a passenger in a taxi violently rear-ended by a drunk driver, was thrown into the front seat area where she was knocked unconscious.
EMS fortunately arrived to take her to an area hospital. She has experienced short-term memory loss, blurred vision and constant headaches ever since – all tell-tale sings of traumatic brain injury or post-concussive syndrome.
Still, my client’s future livelihood is now in the hands of doctors who get paid by insurance companies to author reports limiting my client’s care.
I have not received a finished report yet from any of the three doctors. I am not hopeful. At best, one or two will state some level of care is needed going forward. But I expect the amount and duration of care to be limited, and far short of what my client will need to fully recuperate from her car accident injuries. My client, who has no health insurance, will be forced to stop her treatment – unless a doctor is willing to treat her on a lien – a rare occurrence.
This type of treatment is occurring more often by insurance companies. They are sending my clients to multiple exams with various doctors. Some are neurologists, some are pain medicine doctors, others are orthopedic surgeons. All have a common goal – to write a report that helps the people paying them – the insurance companies.
To combat this, lawyers must be aggressive in how they approach each no-fault case for their client. For example, I often attend the IME with my client to see what the doctor is thinking on a particular case. I will also attempt to put pressure on the insurance adjuster to choose an IME doctor who is less bias than the usual cut-off doctors out there.
All of these approaches, and more, must be used by the plaintiff attorney to protect his or her client from these new IME tricks.