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What is a No-Fault Independent Medical Examination?


If you suffered injuries in a car accident and filed a claim for no-fault benefits, your insurance company may request that you attend an Independent Medical Examination (IME). Despite its name, there is nothing “independent” about these evaluations. Instead, IMEs are conducted by medical professionals chosen by the insurance company after you have received a certain amount of medical treatment for your accident-related injuries.

While the purpose of an IME is to determine whether further treatment is medically necessary — and no-fault benefits should continue — it’s not uncommon for an insurance company doctor to terminate these benefits before an accident victim has fully recovered. Notably, a no-fault IME is not the same as a liability IME, also known as a Defense Medical Examination (DME), which is requested by the defendant’s insurance company.    

What are Your Rights at an IME?

If you are required to attend an IME, it’s essential to know your rights and what to expect. Importantly, the insurance company must provide you with reasonable notice in writing if an IME is requested. The examination must be held at a time and location that is convenient for you.

Although you may reschedule the IME once, it’s vital to ensure you attend the second exam to avoid automatic termination of your No-Fault benefits. Failure to cooperate could also result in your being responsible for the costs of any past treatment paid by no-fault.

An IME can be scheduled in any specialty for which you’ve sought medical treatment in connection with your accident. For example, if you have been seeing a podiatrist for a foot injury sustained in the crash, you would be scheduled for a podiatry IME. If you were treating with a chiropractor, the insurance company would request a chiropractic IME. Other common specialties in which IMEs are scheduled can include pain management, acupuncture, neurology, and psychiatry.

If you’ve been treating with doctors in more than one specialty, an IME may be requested for each specialty. However, the insurance company is only permitted to examine you once per specialty, unless the IME doctor determines that your no-fault benefits should continue.        

What Happens at a No-Fault IME?

It’s critical to understand that the IME doctor who will be examining you is not your treating physician. Typically, they will try to minimize your injuries so that the insurance company can avoid paying out on your claim. Although it’s crucial to answer the IME doctor’s questions honestly, you should not offer additional information — anything you say to the doctor can be used to deny your claim.

Additionally, be aware that you may be watched from the moment you arrive in the parking lot until the time you leave. A doctor may try to discredit you if they observe you doing something you claim you were unable to do as a result of your physical limitations.

Once you are inside the office, you may be asked to fill out paperwork. If you don’t understand one of the questions, it’s best to contact your attorney. You should also request a copy before you leave.

The IME doctor will review your medical records before the examination and ask you questions about your injuries. The doctor will also conduct several tests to determine your range of motion, pain, and discomfort during the examination. While you shouldn’t exaggerate your physical limitations, if the doctor makes you do something that causes you pain, it’s important to let them know.  

What Happens After an IME?

After your IME, write a summary of what happened during the appointment. Within a few weeks, the insurance company will send you a detailed report. If anything in the IME report is inconsistent with what occurred during the examination, it’s best to speak with your attorney.

An IME report is usually several pages long and will include information such as:

  • The medical records the doctor reviewed
  • The date you sustained the injury
  • A summary of how the injury arose
  • Past medical history
  • Physical examination observations
  • Range of motion testing findings
  • A list of diagnostic studies
  • Diagnoses

The report will also document the doctor’s opinion concerning whether further diagnostic testing is necessary, and if you are able to return to work. If the doctor opines that medical treatment should continue, they will schedule a follow-up IME in several weeks.

What Can You Do if Your No-Fault Benefits Were Terminated?

In many cases, no-fault benefits will be discontinued before a patient has reached maximum medical improvement. If the IME doctor determined that you are no longer eligible for no-fault benefits, they will send you a written denial explaining the specific reasons for the termination. But, if your own doctor determines that you will need ongoing medical treatment, you may have several options.

Sometimes, it may be possible to appeal the IME doctor’s decision in arbitration. Otherwise, a medical facility may agree to continue treating you on a lien. It’s best to speak with a knowledgeable personal injury attorney who can advise you concerning the best course of action.   

Contact an Experienced New York Personal Injury Attorney

Car accident injuries can be severe and require extensive medical treatment. It’s best to consult with a personal injury attorney who can advise you of your legal remedies and protect your rights. The Dearie Law Firm, P.C. has over 30 years of experience representing motor vehicle accident victims throughout New York City and the surrounding areas, and is committed to obtaining the maximum compensation in every case.    
The Dearie Law Firm, P.C. has convenient office locations in Manhattan, Brooklyn, and the Bronx, as well as mobile locations serving Brooklyn, Queens, Manhattan, the Bronx, Staten Island, Westchester, Rockland County, and Long Island in Nassau County, and Suffolk County. Contact us today for a free consultation.