The Defense Medical Exam:
Say you’re whacked by a car while out on a ride. You’re hurt, maybe even have fractured bones. The motorists fault is clear, but the insurance company still refuses to promptly pay…. And when they do offer to pay – it’s a low ball settlement offer.
May I let you in on one of the insurance companies little secrets…. it’s how they reduce your fair case value. It’s called an Independent Medical Exam (IME), better know as a “Defense Medical Exam” or “DME”. Here are a few pointers for injured bicyclists when faced with attending an “IME” – “DME”:
Bring along a trained nurse or observer and record the extent of any testing or reporting by the insurance doctor, so you’re not negatively redefined by a defense report or expert testimony in court.
Truthfully disclose all prior injuries or wear and tear on your body….but distinguish it as asymptomatic….a fancy medical term for without symptoms. It’s the symptoms or pain and resulting atrophy of muscle that is compensable. Even if an old injury is aggravated – you can still recover the fair extent of any new injury.
Have your attorney verify if you passed “Waddell’s” credibility tests in the physical exam. If you passed Waddell’s tests, but the positive results were omitted by the IME insurance doctor and you uncover this tactic,… pointing this out in court enhances your credibility. i.e. you were really hurt.
Be prepared to explain why you’re working in pain…. for example…. you need to pay your bills and you’ve taken medication to work through the pain.
Be prepared to explain why there is a gap in your medical treatment… for example …. medical treatment is costly…. 70% of the population is without insurance. Or it was difficult to find a good doctor who will take a lien…. (promise to pay)….or that it took time to get approval to see your health plan doctor.
In conclusion, obtaining full justice often requires a successful IME. Although there’s nothing independent about an Insurance Medical Exam, hopefully these tips will prepare you, when facing off with these insurance doctors who earn hundreds of thousands of dollars a year (and in some cases over a million dollars a year) conducting these “IME’s” on behalf of the insurance industry before Juries, who are usually never fully informed of their financial bias.