If you have been injured in an accident in California, and you:
1. file a lawsuit against the at fault party or party(s),
2. or an arbitration against your own insurance company for uninsured motorist benefits,
As you will read below, IME’s are NOT “independent” in any sense of the word, and they are regularly used by insurance companies to improperly deny benefits to deserving people in their respective accident claims. The problem is at first blush it seems "fair" for an at-fault party to use an IME to understand the injured party's injuries; however, it is my opinion that they have been eroded to "pigeon hole" each injury claim as undeserving, and incentives are given to the IME doctor to be on a mission to look for anything, and I mean anything, that can make an injury case worth less no matter what (it is not about being independent or fair any more, and maybe it never was).
IME’s are simply another example of insurance companies at war with their own customers, and persons who file a lawsuit against their insured (person who was at fault for the California accident). Insurance companies are at their happiest when they are collecting our annual premiums and despise us whenever we file a claim for those benefits we have been paying for for so many years. In fact, when a claim is filed, the first thing that is done by the insurance company is to look for ways to deny the claim! It is about profits, and not paying out on claims.
The official stated purpose for an IME is for the insurance company to have a so-called “independent”, supposedly unbiased doctor, offer a sincere medical opinion on the severity of your bodily injury, whether your injury was caused by the accident, and what will be the appropriate medical treatment of your injuries in the future. Sounds good in theory but the theory starts to break down from the moment the IME doctor is hired; as Sherlock Holmes would say, the "game is afoot."
WHO BENEFITS FROM AN IME? THE INJURED PARTY, OR THE IME DOCTOR??
An IME is conducted by a duly licensed medical doctor hired by the insurance company who practices (usually) in the same community as the injured party, who is paid by the insurance company, and who reports to the insurance company directly. As you might have guessed, the insurance companies who hire these doctors are looking for medical doctors who will tell them what they want to hear and any doctor who regularly tells the insurance company something they do not want to hear is quickly scratched off the IME list. The problem with this is that medical doctors have learned that performing IME exams can be VERY lucrative (how about earning more than $500,000 a year from IME’s alone, you really do not need to have a medical practice seeing patients like other doctors do, huh?). To this end, medical doctors are eager to remain on the good side of the insurance companies who pay them for IME exams.
THE INDEPENDENT ANALYSIS IN AN "IME" TODAY IS FLAWED!
See, when medical doctors are recruited or hired (hired guns) by the insurance companies, they learn in no uncertain terms what the insurance companies are looking for in their final IME report–minimize everything!
1. The medical reports from an IME doc say the person was NOT injured in the accident….
2. If they say they were injured, then they routinely say the injury is NOT due to the accident but is due to a pre-existing medical condition….
3. If they say it was not due to a pre-existing medical condition, then they say the injury really not so bad….
4. If they do say the injury was bad, then they say the injured person has fully recovered and needs no further medical treatment……mmmmmmmmmmm, does the above sound like they pigeon-hole these exams? Yes, they do.
I refer to these biased exams as Insurance Defense Exams, not Independent Medical Exams because that is what they are. This link will tell you what to bring with you or what to expect at your defense IME. I have even seen IME doctors conveniently forget to include prior diagnosis codes or diagnostics in their IME reports. I hope this blog page give you insight into the challenges a injured person faces in California. If you have any questions, you can call me directly at (619) 813-7955.