What's An Independent Medical Examination?

We recently wrote about no-fault insurance: insurance coverage that pays for medical treatment and other out-of-pocket losses up to coverage limits, regardless of who caused the accident, hence the name “no-fault.”

When you receive medical and health treatments via no-fault insurance, New York law allows the insurance carriers to request an “independent medical examination” which is commonly referred to as an “IME.” The purpose of an IME is to determine if the treatment you’re receiving is still medically necessary. If the doctor determines that you are no longer in need of the specific treatment you’ve been receiving since the accident, the insurance carrier will terminate your no-fault benefits.

IMEs are perfunctory examinations, at best. Perhaps more importantly, the doctor who performs your IME is paid by the insurance carrier so, in our experience, the results of IMEs usually end up concluding that the patient is no longer in need of treatment and, therefore, the insurance company terminates the no-fault benefits.

Regardless, when you receive notice that an IME has been scheduled, it is very important that you attend appointment. If you need to reschedule, that’s fine, but don’t blow off the appointment. Failing to show up could result in termination of your no-fault benefits.

And even if you attend and later find out your no fault benefits have been terminated, you still have options to continue your treatment if necessary. First, you can arbitrate the decision. Second, you can use your private health insurance. Finally, many doctors will be willing to treat you risk free. They will then try and get the medical bills paid by having you sign an assignment of benefits giving them permission to arbitrate the bills with the insurance carrier directly and ,should they lose, you will not be responsible for the unpaid bills.

Dealing with the process and protocol of personal injury lawsuits, no-fault benefits, entitlements, etc., can feel like completely foreign territory. If you have questions, please don’t hesitate to contact our office so we can help you determine the best path forward after an accident.