What is an Independent Medical Evaluation (IME) and do I have to go?
An Independent Medical Evaluation” or IME for short, is a general doctor’s visit that is performed by a doctor who generally “works” for the insurance company to determine whether they insurance company should pay for your claim or not.
I am sure by now you have already seen the irony in that statement. “A doc who gets paid by the insurance company is going to tell the insurance company whether I have a claim or not? Wouldn’t the doctor be worried if he recommends payment on too many claims the insurance co will hire someone else?” And….you’d be exactly right.
For this reason alone, workers’ compensation insurance carriers only choose a choice, handful of doctors in the state of Utah who perform these “IMEs” (which are not really independent at all) because these doctors give them exactly what they pay for…A REASON TO DENY A CLAIM.
We even had one claim come through our office where a man’s arm separated from his shoulder in a piece of machinery. One of these IME “hired guns” had the call to recommend denying the claim because the amputated arm was “clearly” because of a preexisting condition. We filed suit, and within weeks had the claim settled for 100% benefits as soon as the insurance attorney reviewed it.
So next you are thinking, “Well, no way I’m going to participate in one of those with a crooked doctor!” Unfortunately, that is an easy way to get your case denied. Utah Rule 601-2-1 states that “Upon reasonable notice, the respondent may require the petitioner to submit to a medical examination by a physician of the respondent’s choice.” If you don’t go, they can deny your claim.
If you think you’ve been victimized by a bad doc who gave you a bum report, call us today to explore your options.
