Imagine if you had been injured — say, in a car accident. Since the accident was clearly the other driver’s fault, you file a third-party claim against the at-fault driver’s liability insurance company. At this point, the issue is not who was at fault. The issue, instead, is how much the at-fault driver owes you for your medical expenses (and other damages).
Now let’s consider the insurance company’s point of view. Insurance companies are for-profit entities. They make money by accepting premiums from clients, and they lose money by paying out claims. That makes their interest directly adverse to yours. Therefore, they will try to minimize the value of your claim.
Insurance companies often employ a tactic to get an accident victim to undergo an independent medical exam (IME) to prove that they have reached maximum medical improvement (MMI), thereby reducing the damages they may be entitled to. Keep reading to learn more here.
Maximum Medical Improvement
You reach MMI when your doctor declares that your medical condition is unlikely to improve any more than it already has. If you’re lucky, that means you have made a complete recovery. If you’re not so lucky, it could mean that you have a permanent disability.
Either way, you’re in a position to demand a certain amount of money from the insurance company to pay for your medical expenses. Since the insurance company wants to pay you as little as possible, you can expect them to dispute the amount of money you say they owe you.
How Does an IME Work?
Insurance companies often use “independent medical examinations (IME)” as evidence that an accident victim’s medical condition is not as serious as they are claiming it is.
An IME is “independent” because the doctor who conducts it is not your doctor. Instead, they work for the insurance company. Of course, the insurance company will claim that their doctor is going to give you an unbiased medical examination.
Underlying Motivation and Conflict of Interest
The opposing party’s insurance company will pay the doctor conducting the IME to generate evidence they can use against you in settlement negotiations, at a deposition, or, if necessary, in court.
Although the doctor who examines you is probably not an employee of the insurance company seeking an IME, they likely make a lot of money from referrals from that insurance company — referrals from people just like you who have filed claims against the insurance company.
These doctors know that if they want further referrals from the same insurance company, they should cooperate with them, which could entail subtle bias in their examination report.
When You Can Expect an IME
You can expect the opposing party to seek an IME if you:
- File an insurance claim against a defendant
- File a lawsuit against the defendant, and the lawsuit makes it all the way to the discovery phase
- Go to arbitration with your insurance company over uninsured motorist benefits
- Suffer several different injuries from the same accident
- Experience a worsening of your medical condition while your claim is still pending
You don’t have to worry even if the opposing party seeks an IME. Your lawyer can hire their own medical experts to examine you and counteract the opinions in an unfavorable IME report.
IMEs and Non-Economic Damages
One of the main reasons why the insurance company might seek an IME is to reduce the amount of non-economic damages (such as pain and suffering) that you receive.
Non-economic damages are threatening to insurance companies because they often amount to a hefty sum of a personal injury claim. From the insurance company’s point of view, the less serious your physical injuries are, the less pain and suffering you are likely to have experienced.
You Need a Lawyer for an IME
The worst-case scenario is that the doctor conducts an IME and comes to conclusions that are seriously adverse to your interests. Although in Louisiana your lawyer cannot attend the IME with you, they can give you good advice in advance and challenge a biased IME later on.
In case you’re worried about being able to afford a lawyer, always remember that most personal injury lawyers will not charge you anything in attorney’s fees unless they win your case. Contact the Kenny Habetz Injury Law to receive a free consultation today at (337) 399-9000.
