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PrairieLaw Auto Accidents Message Board
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Subject: Insurer medical exams (IMEs)

Passing the Medical Exam

By Robert A. Johnson

Every year there are more than 1 million injuries due to motor vehicle accidents in the United States. Many of these injuries are too minor to report, but some are serious enough to require medical treatment, insurance claims and ultimately, lawsuits.

If you are injured and make a claim against the driver who caused the accident, his or her insurance company has the right to have you examined by a doctor of its choice. This is variously called an "independent," "adverse" or "compulsory" medical examination.

Whatever it’s called, the doctor who performs the exam will testify about your injuries for the insurance company who is paying his or her fee. The doctor is examining you not for the purpose of treatment or to help you find relief from your injuries, but to obtain information that will either allow the insurance company to terminate its obligation to pay your medical bills or to question your injuries should your case go to trial.

Here are some tips about what to expect and how to make the best impression possible.

Keep your appointment. Many insurance companies schedule exams through agencies that supply doctors who are willing to perform these exams for insurance companies. Your failure to attend the exam may result in your being responsible for payment of the doctor's fee or the suspension of payment of your medical bills.

Know what you’re getting into. Although the doctor may be honest, he or she has been selected to perform the exam because he or she has a conservative nature and is generally biased against injured claimants. The doctor has been asked to discover information that will either show you were not injured or that you are not entitled to further coverage . Some doctors work regularly for insurance companies and earn a substantial income for performing exams.

Don’t take it personally. It's important to go to the exam with the right attitude. Understand that the exam is standard procedure and try not to be defensive.

Honesty is the best policy. The best way to "connect" with the doctor is to be polite, cooperative, and above all, truthful. If you lie or fake an injury during the exam, the doctor will recognize your deceit and mention it prominently in the report. Try to appear open and forthright by providing helpful and straightforward answers. Also, attempt to make eye contact whenever possible. Although you need to pay attention to the doctor's questions so you can answer them carefully, don't appear nervous.

After all, you know the answers to the questions, so try to stay relaxed.

Preparing for the Exam

Get organized. One way to strengthen your case and be more relaxed during the exam is to gather your thoughts so you can present your medical history in a logical and concise, but complete manner. Here are some topics you’ll cover:

  • Your medical history, including prior injuries;
  • How the accident occurred;
  • What areas of your body were injured;
  • Your primary symptoms;
  • When your injuries cause you pain;
  • Movements or activities that aggravate your injuries and cause pain or discomfort;
  • Treatment or medication that makes your injuries feel better; and
  • Activities that have been affected or limited.

Review the summary with your spouse, friend or co-worker to see if they notice any items you omitted. Review the summary before your exam, but do not bring the summary with you.

Note the date, time and place of your exam and the name of the doctor who will be examining you. Get any directions you need well ahead of time.

Arrive early. You’ll be more relaxed and have time to fill out any forms.

Plan extra time into your schedule. If the doctor is delayed, you won't feel rushed or upset. You will also want to have extra time after the exam to write a summary and call your attorney.

Meeting the Doctor

The doctor will ask questions to formulate opinions about your injuries. Be careful that you understand each question before you answer it. For example, if the doctor asks, "How do you feel now?" you should find out if he wants to know how you feel that minute or at this point after the accident. You may feel pretty well at that particular moment, but may have had pain associated with your injury earlier in the day, so it's important to be specific and accurate in your answers.

Take time to answer all questions carefully. If a question is unclear or confusing, don't be afraid to ask the doctor to explain or rephrase the question before you answer. If you make a mistake, correct it immediately.

Avoid unnecessary elaboration. Remember that the doctor is hired by the insurance company to help its case. So, while you should always answer a question politely, honestly, and completely, don't ramble on or elaborate unnecessarily.

Try to remember what goes on during the exam in as much detail as possible, but don't take notes in front of the doctor or bring a tape recorder into the exam — that could make it appear that you are more interested in getting money for your injuries than in improving your health.

Be honest and precise. During the exam, you'll be asked to describe your pain and discomfort. Since pain is subjective, it may be best to describe your pain by referring to what areas of your body hurt when you do certain movements or activities. Be as truthful and accurate as possible. No one likes complainers who exaggerate their injuries. On the other hand, don't understate your pain and the problems it causes you.

Behave consistently.The doctor will be observing you during the exam and looking for inconsistencies. For example: You tell the doctor that you can't turn your head to the right. Later, the doctor goes to your far right and asks a question. You turn your head all the way to the right to look at the doctor. Your physical action of turning your head is inconsistent with your prior response.

The Physical Exam

After taking a medical history, the doctor will make a physical exam. The exact procedures vary based on your injuries and the doctor.

Here are a couple things to avoid. Do not:

  • Do not volunteer any information not requested.
  • Do not discuss who is at fault in your case.
  • Do not discuss settlement of your case.
  • Do not allow the doctor to take X-rays or conduct other diagnostic tests.
  • Do not take any written or psychological tests such as a MMPI.
  • Do not go to any other doctors or facilities without your attorney's approval.

Is extremely important to note the exact amount of time the doctor spends actually examining you because the doctor will prepare a detailed report regarding your injuries despite having only spent a short time actually examining you.

During the course of your exam, without the doctor knowing it, keep track of the time the doctor spends with you and what is being done during each time period. For example:

2:00 p.m. Arrive at the doctor's office.

2:15 p.m. Appointment time

2:30 p.m. Go to examining room

2:40 p.m. Doctor arrives in examining room.

3:00 p.m. Interview ends, told to undress, doctor leaves

3:10 p.m. Doctor returns and begins exam

3:15 p.m. Examination over

3:20 p.m. Leave clinic

After the Exam

Once the exam is over and you have left the doctor's office, prepare a written summary containing the following information in as much detail as possible:

  • What the doctor said to you;
  • What you answered;
  • What, if anything, was dictated into a tape recorder by the doctor during the exam;
  • What tests or procedures the doctor performed;
  • How much time the doctor spent with you;
  • What was done during each time period; and
  • Any inappropriate or unusual questions or comments made by the doctor.

The doctor will prepare a report for the insurance company describing his examination of you, along with his findings and opinions. It is extremely rare for the doctor to determine that you were injured in the accident or recommend any further treatment.

If you feel you have made a good impression, ask the doctor what treatment he or she would recommend for your injuries. Your questions may prompt the doctor to treat you as a patient, rather than an insurance claim.

Robert A. Johnson is a partner at Mansfield Tanick & Cohen, a Minneapolis firm that provides legal services to individuals, families, businesses and organizations nationwide. His practice areas include personal injury cases and motor vehicle accidents.

Web site: http://www.mansfieldtanick.com


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