Independent Medical Exam (IME) Law

According to Massachusetts General Laws Chapter 90, Section 34A, all automobile insurance companies in Massachusetts must provide Personal Injury Protection (PIP)benefits to their insureds. The practical effect of PIP in action, and how it affects your business, is found in Massachusetts General Laws Chapter 90, Section 34M.

We are all familiar with the IME. The insurance companies prefer to call it an “independent” medical examination. However, given the fact that the statute gives the insurance company the right to select the physician (“The injured person shall submit to physical examinations by physicians selected by the insurer as often as may be reasonably required . . .”) the client/patient shall see, on top of the fact that no doctor/patient relationship is established, there is little doubt that the better name for these types of examinations is Insurer’s Medical Examination.

Who Get’s Sent For Insurance Medical Exams

What causes some insureds to get tapped to attend the IME? That’s not an easy question to answer, as there are myriad factors that go into that consideration. But the most common links we see are the following: 1) previous PIP claims involving the same and/or similar injuries; 2) claims filed within close proximity; 3) little or no physical damage to the vehicles involved in the collision; or, 4) an on-going investigation by the insurance company as to geographic areas, certain providers, etc.

No matter what name is given to the IME or the reason the insurance company sent your patient the IME notice, cooperation is key and your patient must attend the examination without fail. Failure to attend a properly scheduled IME can, and most likely will, result in the full and outright denial of all PIP benefits (“Noncooperation of an injured party shall be a defense to the insurer in any suit for benefits authorized by this section”).

The outcome of the examination ultimately effects when, how, and how much of the bills you submitted to the PIP insurer for treatment get paid. An IME can be conducted by a physician of the insurer’s choosing. Thus, for the purposes of an IME there is no “like-kind” requirement; meaning that the physician chosen by the insurer does not have to have the same practice specialty as the patient’s/client’s treating provider. (Note that this differs from paper records reviews which do have a “like-kind” requirement.”)

How To Dispute IME Findings

What do you do if you disagree with the findings of the IME? The first and perhaps most important item is to write a rebuttal. Your rebuttal does not have to be a dissertation. But it should address a few salient points regarding your disagreement with the IME findings. It is okay to have a rebuttal “form” that simply adds, takes away and addresses each IME and patient individually. The rebuttal form lays the foundation for challenging and ultimately seeking legal redress from the insurer for disputed amounts not paid.

What Experienced IME Lawyers Can Do To Help

Please also check our website for further information on new personal injury laws that Massachusetts Courts have recently decided, that affect the way conducted IME’s and their results are challenged by providers all over the state. Our website is the best and easiest way to stay up to date in this continually developing area of law. We frequently write articles concerning changes to Insurance Records Reviews and Settling Outstanding PIP Claims.