Playing the insurance claim game – be ready for your IME
Lots of things come with insurance claims: paperwork, lawyers – and independent medical exams (IMEs). Learn what comes with an independent medical evaluation (IME), including what to say and what NOT to say.
Any sort of accident comes with lots of insurance requirements, so you'll constantly feel as if you are jumping through hoops. The IME, however, is a whole different ball game.
What is an independent medical evaluation (IME)?
When you get into an accident and submit an insurance claim for reimbursement, sometimes your insurance company wants to make sure that you are as injured as you've claimed.
An IME is a doctor's appointment, but with a doctor on the insurance company's payroll.
Many insurance policies actually mandate that you submit to IMEs or automatically forfeit any reimbursement; additionally, courts can mandate that plaintiffs submit to an IME, if you feel like skipping.
So, don't think you can get out of this one.
Some even call the IME an insurance medical exam, believing it is intended to minimize your insurance payout.
Because the doctor is paid by the insurance company, many attorneys feel that the result is a foregone conclusion. Some even call these “insurance medical exams” because they are intended to minimize your insurance payout.
Indeed, most results are hopelessly skewed to represent the outcome that the paying entity wants.
Courts and arbiters take this into account during settlement phases, of course, because there are some things that doctors can't spin: range of motion tests, X-Rays, CT scans, MRIs and other hard tests, for example.
If the results are skewed in an IME, then what's the point?
This has been debated by lawyers for decades, and the result they keep returning to is that it's one of those necessary evils.
Insurance companies can't trust your doctor; what if he's lying for you?
They need someone they can trust to examine you as well. And if the doctor interprets that as massaging the results a bit so he can keep the pipelines of work flowing, well...
An IME begins as soon as you arrive at the doctor's office. We're not talking inside the waiting room – we're talking the parking lot.
Even a biased result can show more than a bit of truth, and attorneys know how to sift through the dirt to find gold. For example, even the most biased of doctors can't make you move your arms more than you're physically capable of doing. There are several ways of showing how limited you are.
An IME begins as soon as you arrive at the doctor's office. We're not talking inside the waiting room – we're talking the parking lot. Some doctors have their staff watch you walk inside so they can compare how you act later. No, we're not joking. The exam begins and ends in that parking lot. They will continue to watch you in the waiting room.
Enjuris tip: Some people ask how they should dress and act during an IME. It’s best not to act any differently than usual, and you don’t need to be dressed up. A good recommendation is to be comfortable – wear sweatpants and a T-shirt, since you’ll most likely change into a hospital gown for the examination.
Your friend can write down everything that happens during the appointment. You will bring your list of medications and your medical record. Have everything numbered, and if the doctor asks to make copies, make sure you get everything back. You'll want to leave with exactly the same number of papers as you arrived with.
The actual examination
Arrive at least 15 minutes early. Be cordial, but don't be overly bubbly, even if it is your personality. Remember, this doctor has been employed to minimize your insurance payout. He is tasked to disbelieve everything you say. Don't give him extra ammunition.
You'll likely have to fill out a medical questionnaire in the waiting room that includes a pain scale.
These measure your pain on a scale from 1 to 10. Everyone thinks they should jump to an 8 or higher, because “then they'll take me seriously!” When you do that, they think you're exaggerating unless they know you already. An 8 is comparable to childbirth. A 10 is comparable to being eaten by a bear. Keep that in mind when you fill out the form.
On your pain scale, 8 is comparable to childbirth. 10 is comparable to being eaten by a bear.
Have your scribe keep notes of when you arrive, when you sit down and when you meet with the doctor.
Can I record my IME?
Some people have asked whether you can record an IME, since recording devices are so prevalent these days.
However, this is an extremely touchy subject, especially since neither the doctor's attorney nor yours will likely be present. Depending on the state, the doctor has to be aware that he is being recorded and must consent. It's best to keep to a pen and paper during the appointment.
Don't let this doctor take any X-Rays or other hard tests without your attorney's permission.
Since your attorney will not be present, the doctor might try to pressure you into a test. Don't be swayed or intimidated. They might say something like, “Oh, I guess we'll have to reschedule.” If you can't reach your attorney to ask about the test, then reschedule. Don't do anything more than simple physical examinations.
Enjuris tip: Be completely honest. Don’t try to create new injuries. Don’t make your current injuries sound worse than they are. Just be yourself, explain your injuries and lay it all out on the table.
Most appointments should last 30 minutes to an hour. He or she will do a simple battery of tests that include range of motion, reflexes, pain response, Q+A, medical history, walking (such as on your heels and toes) and maybe some others. Be complete with your medical history. Include everything, even if it doesn't pertain to the accident.
Here are some tips:
Be lyrical with your wording. Don't say “painful” or “it hurts” – say it stabs, it burns, it wrenches. Does your head hurt, or is a rusted ice pick slamming up underneath your occipital ridge?
HOWEVER: Make sure you completely understand each question before you answer it. Take a few seconds to think, and don't be afraid to clarify if you don't understand.
Don't expect every test to hurt. Doctors have ways of doing range of motion tests that don't cause pain, so even if he says, “Tell me when it hurts,” don't immediately respond with, “Ow.” Conversely, if something does hurt, don't be afraid to speak up.
Cooperate fully and don't be rude. The doctor is doing his job, and so are you. The least you can do is be polite.
At the same time, understand that the doctor might be distracting you so he can find inconsistencies in your story. That is the crux of an IME. If he can weaken your narrative, then the insurance company doesn't have to pay you as much. Be consistent. Be clear. Tell him what hurts and where. That is the only way to fight him.
Don't talk to the doctor about the specifics of the case or anything about your life beyond small talk. Even if the silence in the room is deafening, let it be uncomfortable. Ask him about his kids or where he wants to go on vacation if you have to. Talk about your favorite books, movies or music.
When the examination is done, thank him for his time and make sure that you have all the materials with which you arrived. Then, when you are driving home, have your friend or relative transcribe your post-appointment impressions of the IME. All of these notes will be given to your attorney.
If the results turn out to be incredibly unfair, your attorney will be able to argue inherent bias – and he'll also be able to point out the obvious, like your injuries that cannot be spun. Those usually cannot be buried even in the most biased of reports.
And that's it. It will be an exhausting experience, even if it takes less than an hour. You might have to do more than one IME if it's a big case. Just nod and smile. IMEs are, as we said above, a necessary evil. Now you know how to handle yourself accordingly.