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Independent Medical Examinations - A tool to deny, delay and defend in claim handling

The weapons and tactics that insurance carriers have at their disposal in combating personal injury claims are kept secret for good reason from the general public. Insured’s often go years with faithful dedication to their insurance company manifested through timely payment of monthly premiums and renewing year after year. These consumers are often blind to the reality of insurance companies and the claims handling process until an action taken by such carrier shows the callous and adversarial nature that insurance entities take against their claimants. As a Clearwater personal injury attorney, my clients often state “there is no way that my insurance company would not be there for me in my time of need…I have been faithful to them and we have a contract." As an automobile accident and motorcycle accident attorney, I have learned that such expectations are sadly far removed from reality.

Unfortunately, in today’s climate we find insurance companies imposing hard nose tactics during the claims handling process. This ideology of deny, delay, defend is for the sole purpose of swelling the ever growing profit margins of the insurance industry. One such tactic is the “Independent Medical Examination (IME)."

What is an IME? An Independent Medical Examination is when an insurance company requests that the claimant be evaluated by a third party doctor hired and paid for by the very insurance carrier, to render a clinical evaluation after the injured party has been treating with other doctors. After the IME is concluded the physician will provide the insurance carriers a report stating their opinions about the claimed injuries. These reports include, but are not limited to determining whether the injury is related to the actual event, whether the patient has reached maximum recovery from treatment, and whether the patient has sustained a permanent injury. These and others are textbook defense’s asserted by insurance carriers to either cease paying for additional/future treatment, deny liability, or mitigate their exposure in paying claims. As a personal injury attorney who regularly litigates on behalf of victims of automobile and motorcycle accidents, I can generally expect the insurance carrier to request an Independent Medical Examination after they begin receiving bills generated and submitted by a medical provider on behalf of my client.

What Doctors perform IME’s for insurance companies? Fortunately, a series of case law from the Courts have allowed attorney’s to delve deep into the relationship between physicians who perform Independent Medical Examinations and the carriers who hire them. Generally the physician performing the IME derives a substantial portion of their income from conducting such medical examinations. Essentially, the insurance company hires the same physicians in the same geographic area time and time again. This is not done for mere convenience. Rather, the hiring insurance carrier is fully aware that they will obtain a favorable defense report and an opinion that will benefit their bottom line. These doctors are essentially hired guns. Generally, these doctors are not standouts in the world of medicine but doctors who for some reason or another have fell into the stable but dubious practice of working at a flat rate per IME performed.

Insurance companies argue that there is rampant fraudulent claims and disseminate a campaign of disinformation to the public to convince consumers that most claimants involved in a car accident are solely after a paycheck by perpetuating nonexistent injuries. This is not reality. Reality is that car accidents occur every day and everywhere. I rarely come across fraudulent claims or malingerers in my practice yet the applicable insurance carrier treats most of my clients like such. Even a minor motor vehicle collision can cause serious injuries and result in the need for consistent future medical treatment. When this happens to you or a loved one you expect that the insurance company you stroked a check to every month for so many years would stand by your side. Fortunately, some insurance companies do and continue to do the right thing. Unfortunately, the majorities of carriers do not see the person but see the bottom line and employ tactics such as an IME as weapon of choice in their campaign deny, delay and defend.

-Christian Myer, Esq.

Christian Myer, Esq., is a civil trial, automobile accident and motorcycle accident attorney at the Dolman Law Group. He limits his practice to first and third party insurance claims relating to catastrophic injuries, traumatic brain injury, motorcycle accidents, automobile accidents, insurance carrier bad faith and premises liability.

Dolman Law Group is a Pinellas County personal injury and civil trial law firm based in Clearwater with satellite offices in Bradenton and Melbourne. The attorneys at Dolman Law Group regularly litigate on behalf of injured victims of automobile and motorcycle accidents in Pinellas, Manatee, Sarasota, Hillsborough, and Pasco County. For more information on Christian Myer, Esq., or the Dolman Law Group, please email me at: [email protected]

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