Independent Insurance Medical Examiner


 
The next tactic of the first party carrier will be the use of an actual IME. A doctor sympathetic to the insurance industry most often conducts the IME. SettlementCentral.Com provides tactics for responding to the IME letter and deciding whether to proceed with medical care in our Independent Medical Examinations Members onlyMembers only section. You can expect an actual IME doctor to be utilized if you are being treated with continuing and expensive medical or chiropractic care, or if your dentist has diagnosed a TMJ and you are receiving new or modified appliances every few months. In these cases, be aware that there are ramifications whether you choose to participate in the IME or to decline. As noted in the section on Independent Medical Examinations Members onlyMembers only, these reports sometimes find their way into the files of the third party carrier. At a minimum, the third party carrier may find out that you have had an IME and may request a copy.
 
There are also certain tips on techniques for taking the IME, and you will want to be familiar with those if you choose to go forward with the exam. Members onlyMembers only The insurance company knows that the IME will fulfill its goal, which is to terminate the insurance company's responsibility for payment of your medical costs.
 
As a side issue here, you might wonder why your own company wants to terminate medical costs payments when it will be reimbursed out of the settlement from the tortfeasor. This topic is discussed in the IME section Members onlyMembers only. Briefly, the value of money over time is a key consideration, as well as the fact that your own company probably has an experience ratio in receipt of subrogation of first party payments of something around 50 percent. This is because, on the whole, first party payments are required whether or not there is a third party to pay. Furthermore, even when a third party does pay, there often is reduction for costs of collection and other factors involved in subrogation.
 
The point is, if they are only receiving 50 percent back in subrogation, your insurance company has a tremendous incentive to keep its first party payments low. Even with the monies that receives back, it has lost the value of that money over the time it was in other parties' control. The insurance industry is one of the wealthiest and most stable in the country. Part of the reason for this is sound investments. Those companies make good money on their investments and, even if they are covering a first party medical payment dollar from the tortfeasor two years hence, they have lost the investment value of the dollar for those two years. This is another reason why the insurance industry will fight hard to keep from paying medical bills if the bills are not fully recoverable.
 
What is the first party carrier is seeking to achieve through the use of the IME? The conclusion they are really seeking is that the patient has reached maximum medical improvement (MMI) or final medical stability. Either way, that is all the authority your company needs to stop paying. Your massage therapist, physical therapist, chiropractor or doctor does not have undisputed credibility with the insurance adjuster. Your insurance company just wants someone with a medical license to state that no further such treatment is warranted in your case - that it is no longer reasonable or necessary -- or that the medical costs are excessive, so they can stop your medical payments.