If you’ve been injured in a car accident in New York, your no-fault insurance carrier may require you to attend an Independent Medical Examination (IME). This evaluation is a crucial step in the claims process, as the insurance company uses the results to determine the extent of your injuries and whether ongoing medical treatments are necessary. Understanding what to expect at an IME can help you feel more prepared and protect your rights.
Why Are IMEs Required?
In New York, no-fault insurance typically covers medical expenses and lost wages, regardless of who was at fault in the accident. However, insurance companies are vigilant about preventing fraud and may question the necessity or extent of ongoing treatments. An IME allows the insurance company to have a medical professional evaluate your injuries to verify:
- The severity of your condition.
- Whether the injuries are consistent with the accident.
- The necessity of ongoing or future medical care.
- Your ability to return to work.
It’s important to note that the medical professional conducting the IME is not your physician. Instead, they are hired by the insurance company, which means their primary interest is assessing your claim from the insurer’s perspective.
How Will You Be Notified?
If your insurance company requires an IME, you will receive a notification with the following details:
- The date, time, and location of the examination.
- The name and specialty of the examining physician.
- Any specific instructions, such as bringing medical records or imaging results.
- Information about rescheduling or what to do if you cannot attend.
Failing to attend the IME without a valid reason can result in denying your no-fault benefits, so carefully read the notice and follow the instructions. If you cannot attend on the selected date and time, notify the insurance company immediately to reschedule.
Preparing for the IME
Preparation is key to ensuring that the IME goes as smoothly as possible. Here are some steps to take:
- Review Your Medical Records: Familiarize yourself with the details of your injury, including your symptoms, treatments, and progress.
- Be Honest and Consistent: Any inconsistencies between your account and your medical records can harm your claim.
- Bring Necessary Documents: Include any requested medical reports and imaging results (like X-rays or MRIs).
- Dress Appropriately: Wear simple clothing that allows for easy examination of the affected area.
- Be clear and consistent when describing how the accident occurred, the resulting injuries, and the pain you are experiencing.
What Happens During the IME?
The IME is generally brief, lasting between 15 and 30 minutes. The structure typically includes:
- Medical History Review: The doctor will ask you to describe how the accident occurred and the injuries you sustained. Be specific about your symptoms and their impact on your daily life.
- Physical Examination: The doctor may check:
- Range of motion.
- Areas of pain or tenderness.
- Strength and reflexes.
- Visible signs of injury (like bruises or swelling).
- Diagnostic Tests: In some cases, additional tests like X-rays or MRIs may be performed to assess internal injuries.
- Discussion of Treatment: You may be asked about the treatments you’ve received, such as physical therapy or medication, and whether they have been effective.
- Observation: The doctor may note how you move and behave before and after the formal examination to see if your actions match your reported symptoms.
What Not to Do During the IME
- Do Not Exaggerate Symptoms: Be truthful and consistent. Overstating your pain or limitations can damage your credibility. However, you should tell the doctor about all of your symptoms.
- Do Not Discuss Your Case: Do not discuss your lawsuit, legal strategy, or opinions about the accident.
- Do Not Argue with the Doctor: Remain calm and cooperative. Disputing the doctor’s views during the exam may negatively impact the report.
- Do Not Hide Pre-Existing Conditions: Be upfront about any past injuries or conditions related to your current symptoms.
What Happens After the IME?
The examining doctor will draft a report summarizing their findings and conclusions. This report will include:
- Their professional opinion on your injury.
- An assessment of your treatment to date.
- Recommendations for further care (or lack thereof).
- An evaluation of your ability to return to work.
The insurance company will use this report to decide whether to continue paying for your medical treatments and lost wages. If the doctor concludes that your injury is not as severe as claimed or that you have recovered sufficiently, your benefits may be reduced or terminated.
Challenging an Unfavorable IME Report
If the IME report is not favorable, you have options to contest it:
- Consult Your Attorney: A lawyer can guide you on how to dispute the findings.
- Submit Contradictory Medical Evidence: Gather medical records from your treating physicians that support your claim.
- Request a Second IME: In some cases, you may request another independent evaluation.
- File for Arbitration: If the insurer denies or reduces your benefits based on the IME, you can challenge the decision through the New York State Department of Financial Services arbitration process.
Independent Medical Examinations can significantly impact your no-fault insurance claim. You can better protect your interests by understanding the process, preparing adequately, and knowing what to expect. Remember, honesty and consistency are crucial during the IME, and legal guidance can help you navigate the complexities of your case.
Why Legal Assistance Matters
Navigating the no-fault insurance process, including dealing with IMEs, can be complicated and stressful. Since the insurance company’s goal is often to minimize payouts, having an experienced attorney on your side can help protect your rights. Your attorney can:
- Prepare you for the IME.
- Address unfair or biased reports.
- Challenge the insurance company’s decision if your benefits are unjustly reduced or denied.
If you have questions about your IME or need assistance disputing a report, contact the personal injury attorneys at Lacy Katzen today.
