What to Do If an IME Report Denies Your Claim

Posted on behalf of RizkLaw on Jan 30, 2014 in Personal Injury

If you feel that the Independent Medical Examination (IME) your health insurance company or employer required you to take has unfairly concluded that you have reached maximum benefit from your injuries and no longer need care, there are things you can do to counter that decision.

How to Challenge a Bad IME Report

IMEs are conducted by doctors who regularly work for the insurance company, so a doctor’s report for the insurance company will tend to minimize the extent of your injuries. There are several things you can do and say, after the exam, during your negotiations with the adjuster to counter a bad report.

• Ask for a copy of the report. You should refuse even to discuss the report with the insurance adjuster until you have a complete copy — not just portions of it or the adjuster’s version of what it says.
• If the examination was in any way unfair — very brief or superficial, or taken without first getting a thorough medical history from you of your symptoms — then point this out to the adjuster, and tell the adjuster that a friend or family member who attended the IME with you can support your side.
• Point out to the adjuster any inaccuracy or incompleteness in the report, as an indication of its unreliability as a true measure of your injuries. If possible, use material from your own medical records to point out the problem.
• Contrast for the adjuster the very brief extent of the IME with the much more significant time your own doctors have spent diagnosing and treating your injuries.
• If the IME report is extremely negative and the adjuster seems to be relying on it heavily, denying you a fair settlement, ask your own doctor to write a response countering the IME report.

It is advisable to seek the help of an experienced disability attorney to guide you through this process and reverse an unfavorable IME report.