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Independent medical exam: should i go?

Brooklyn, NY |

i was in a car accident in June, 2012: A 18-wheeler truck hit me in the left-rear-side of the driver door causing whip lash and muscle spasm. I have bee in therapy for almost 13 weeks and now i feel fully recovered.( Thank God!) Now my insurance company wants to deny my claim and wants me to go to an independent medical exam. Obviously, the insurance doctor is not going to find any problem because i am fully recovered. Shouldn't they have done this exam right after the accident. What should i do?

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Attorney answers 5

Posted

You should be thankful you're fully recovered and that the carrier did not deny you're claim before you we're fully recovered. It is commonplace for companies such as progressive, liberty mutual, geico and others to prematurely deny claims. Sometimes they take effort to deny claims within days of a collision. Even if you are fully recovered you need to attend the examination. Failure to attend may jeopardize any pending bill and will jeopardize any future need for treatment. Speak with a local attorney.

Personal injury cases only; I'm good at it; you be the Judge! All information provided is for informational and educational purposes only. No attorney client relationship has been formed or should be inferred. Please speak with a local and qualified attorney. I truly wish you and those close to you all the best. Jeff www.nyelderinjurylaw.com

Asker

Posted

Thank you for your advice.

Jeffrey Mark Adams

Jeffrey Mark Adams

Posted

Your welcome

Posted

First of all, after being in an 18 wheeler wreck, I wonder if you are better physically, but not better mentally because these wrecks can have a lasting effect on a person's ability to drive on the highways where truckers are normally found. If you are having these issues, I would recommend talking to your doctor about what to do about it because the last thing you want to do is be on the road and have a reaction to an 18 wheeler bombing down the highway and then you become a danger to others because of this past experience.

That being said, It is "normal" for an insurance defense lawyer to ask for a medical exam. They try to call them Independent Medical Exams (IMEs). We call them Defense Medical Exams (DMEs). The doctor doing the exam may ask questions about the wreck and may try to interrogate the subject of the exam. We have been successful in having our judges allow another person in the room (and sometimes we are allowed to videotape the exam). This prevents the ins. company doctors from being anything but polite during the exam. When we have been allowed to have a video camera at the examination, the doctors tend to move very quickly through the exam and some refuse to even do the exam (to their own detriment).

If a Plaintiff refuses to undergo the DME, then a judge can order the plaintiff undergo the DME. I always require an order from the judge so that I can insure that there are protections for my client written into the order.

Finally, remember that the examining doctor is not your doctor, and you are not a patient. There is no doctor-patient relationship between you and the ins. co. professional testifier - or what the carriers like to call "independent medical examiners" - ha. Talk to a lawyer who knows what he's doing before you agree to anything or before you discuss anything else with the insurance carrier.

Asker

Posted

Thank your for your advice!

Posted

The short answer is YES; you should go. If you don't the insurance company will continue to deny your claim on the grounds that there is no independent evidence of the harm you claim to have suffered.

Just remember that such exams are not "independent;" they are conducted by doctors working for the insurance company to provide the results of such exams to the insurance companies for use by the insurance companies.

The foregoing is for general information purposes and does not establish an attorney-client relationship.

Posted

The good news here is that you feel as though you are recovered. In that respect, the no-fault system in New York has served you well. It is set up to cover all basic economic loss for those people injured as a result of car accidents. This is something that I am sure you are aware of at this point, but just in case you were not, what follows are some of the specific benefits to which you are entitled (this was pulled from the NF2 cover page):

The New York No-Fault Law provides for the payment of benefits to victims of motor vehicle accidents to reimburse them for their basic economic loss. Briefly summarized, basic economic loss consists of up to $50,000 per person in benefits for the following:

a. all necessary doctor and hospital bills and other health service expenses, payable in accordance with fee schedules established or adopted by the New York State Insurance Department;
b. 80% of lost earnings up to a maximum monthly payment of $2,000 for up to three years following the date of the accident;
c. up to $25 per day for a period of one year from the date of the accident for other reasonable and necessary expenses the injured person may have incurred because of an injury resulting from the accident, such as the cost of hiring a housekeeper or necessary transportation expenses to and from a health service provider; and

As far as the no-fault exam is concerned, it is standard in every claim and must be attended. However if you are unable to attend the first scheduled appointment they will reschedule the date at some point a few weeks later. This can be beneficial if you are still receiving treatment as your benefits will continue until the examination.

Assuming your treatment has concluded, and that there is no objective evidence of an injury (shown by x-ray or MRI scan), then the appointment really is of no great consequence. They will discontinue your benefits under the no-fault policy - but you didn't need them anymore.
However if you do have some evidence of an injury, before you determine that you are "recovered" you should probably think about how you are feeling when you wake up, go to sleep, stand/sit in one place for too long, engage in prolonged activity and whether those activities are different now than before the accident. Also speak to your own treating doctor about the ramifications of your injuries, their lasting effect and the likelihood that you will have periodic exacerbation and aggravation of the problems.

Assuming you are recovered and that you don't need additional care, the best thing to do would be to go to the exam and then move on with your life. If you are not recovered, you should immediately contact an attorney to discuss your options.

Good luck!

The aforementioned opinion does not constitute legal advice and is for general informational purposes only. See an attorney licensed in your jurisdiction for competent legal advice. No attorney-client relationship has been formed through the within legal question and answer session.

Asker

Posted

So, does that mean that they will pay medical cost incurred until the IME date and nothing after that?

Anthony A. Ferrante

Anthony A. Ferrante

Posted

If there is a denial after the examination, then the answer is yes. Not only medical costs will be cut off, but also lost wages, transportation/prescription costs and all other no-fault covered expenses.

Posted

Yes you should attend the examination. If you don't, the carrier will deny you coverage on the basis of a policy violation which is much more difficult to challenge than a denial on the basis of having reached maximum medical improvement. You never no if you're going to need some treatment going forward.

Disclaimer- The information you obtain at our web-site or through postings on such sites as this is not, nor is it intended to be, legal advice. You should consult an attorney for specific advice regarding your individual situation. Any response given here is not intended to create, nor does it create an ongoing duty to respond to questions. The response does not form an attorney-client relationship, nor is it intended to be relied upon as legal advice. The response given is based upon the limited facts provided by the person asking the question. To the extent additional or different facts exist, the response may change appropriately.

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