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What is an Independent Medical Exam?

In New York, any medical bill that you incur due to injuries suffered as a result of a car accident must be put through your automobile insurance carrier’s no-fault policy. As a result, your automobile insurance carrier has the right to request that you attend independent medical exams (IMEs) from time to time to determine if the treatment that you are receiving is still necessary. If after attending an IME, the carrier feels that the treatment is no longer needed, your benefits will be terminated, and your medical bills will no longer be paid.

Six important tips to know about IMEs to better maximize your benefits

  1. An IME is anything but independent, the doctor that is performing your IME is hired and paid for by the insurance carrier. Since no-fault claims are quite common, be certain that your IME doctor performs many IMEs for the insurance carrier. As such, the doctor knows that if they want to keep on getting hired, they better recommend terminating benefits if they can. So, most IME doctors will lean towards terminating your benefits except in extreme cases where terminating benefits would be clearly unfair.
  2. You have the right to reschedule your IME once. The first IME appointment can be rescheduled for any reason. However, should you be unable to attend your second IME appointment, your benefits will be denied without exception. Therefore, if you do decide to reschedule your first exam, make sure you attend the subsequent exam.
  3. You have the right to receive a full copy of your no-fault examination report from the insurance carrier, this report will list the records the examiner reviewed prior to the exam. It will also list any tests performed and the results. Finally, it will give a diagnosis, prognosis, and determination of whether continued treatment is needed.
  4. Your no-fault IME doctor must specialize in the field of medicine that they are examining in reference to. For example, an orthopedic IME doctor is needed to terminate your orthopedic benefits and a neurological IME doctor is needed to terminate your neurological benefits. However, a doctor can terminate treatment related to their specialty. For example, an orthopedic doctor can terminate your physical therapy.
  5. Should your medical benefits be terminated you have the right to appeal the decision. The appeal process is pursued in the form of an arbitration. Unfortunately, the process is long and complicated. The good news is that many healthcare providers will arbitrate on your behalf. So, before you decide to stop treating following a no-fault IME denial, speak to your doctor.
  6. If your no-fault benefits are denied, you have options. First, as discussed above, you or your doctor can appeal the denial. You can also use your private insurance once your no-fault benefits are denied. Finally, you can ask your doctor to hold all bills until your injury case is settled, if you are pursuing an injury case, then the bills can be paid out of the settlement.

No-fault insurance including IMEs can be extremely complicated, it is never a bad idea to consult with a personal injury attorney immediately if you are injured in an accident. They can often do more for you if they are involved from the beginning rather than calling them only when a problem with your benefits arises.

About the Author

Steven Palermo is the managing partner for Palermo Law, Long Island’s Personal Injury Law Firm. He has been helping people receive compensation for their injuries for over 21 years. He focuses on cases involving car accidents, truck accidents, construction accidents and slip and fall injuries.

His book The Ultimate Guide to Handling New York Car Accident Claims details the ins and outs of a car accident claim in a simple, easy-to-read manner.