As a personal injury law firm in NYC, we emphasize to our clients how much a medical diagnosis can impact their compensation after an accident. As a victim, you can rely on medical evidence to demonstrate the extent of your injuries and justify why you are claiming a specific amount as compensation. However, when insurance companies hire doctors to conduct Independent Medical Examinations (IMEs), there is always the chance that the insurance doctor disagrees with your diagnosis. This disagreement can lead to reduced benefits, delayed payments, and sometimes, the denial of claims. In this post, the team at Gabriel Law will break down when insurance doctors disagree with diagnoses and what you can do to protect your rights and get the compensation you deserve.
What is an Independent Medical Examination (IME)?
An Independent Medical Examination (IME) is a non-treating medical evaluation that is conducted by a physician or medical professional selected and paid for by the insurance company. The objective of the IME is to get an “objective” third-party opinion of the nature of the claimant’s injuries and to assess whether treatments are necessary or if benefits should be discontinued.
Why do insurance doctors disagree with your diagnosis?
Insurance doctors that conduct an IME can disagree with the prognosis of your treating physician for a number of reasons. They include:
- Financial and cost-control objectives—Insurance companies are profit-generating enterprises. That being the case, insurance adjusters will hope that an IME will reveal something that can help them limit or deny your claim.
- Different definitions of recovery – Your doctor may define “recovery” in terms of your overall physical and mental well-being, whereas the insurance company might define it simply as the ability to return to work.
- Standard guidelines vs. individualized care—Insurance companies often use rigid, generic guidelines that are designed to treat “average” patients. These guidelines may not always align with your needs following an accident.
How can these disagreements affect your claim?
Should the findings of the IME conflict with your treating physician’s findings, it can affect your insurance claim in a number of ways. The effects can include:
- Denied medical benefits and treatments—The insurance company can stop paying for treatments, citing that they are not severe or unrelated to the accident.
- Termination of wage benefits – If the IME doctor concludes that you are fit to return to work, the insurer can terminate compensation benefits. As such, an employer may even pressure you to prematurely return to work.
- Reduced settlement value – Insurers can use the findings of the IME to justify a lower settlement offer. This is a common tactic used by insurers to get you to settle for lower offers.
- Delayed claim processing – The disagreement will result in conflict, which will require additional processes that will cause a delay in the claim being processed.
What should you do if an IME disagrees with your doctor’s diagnosis?
When the IME disagrees with your doctor’s diagnosis, here’s what you can do to protect your rights and further your claim for compensation.
- Request and review the IME—Get a copy of the IME and, with the help of an accident lawyer in NYC, check for inaccuracies, missed information, and incorrect statements in the IME.
- Get a rebuttal from your doctor—Ask your treating physician to review the IME and provide a written statement that can be used to rebut the assertions of the IME.
- Document everything—keep detailed notes on your symptoms, levels of pain, and how the injuries have limited your ability to engage in daily activities.
- Work with a New York City auto accident attorney—an experienced lawyer can help you challenge the IME by examining the surrounding circumstances and strengthening your case.
Conclusion
When an insurance company disagrees with your physician’s findings through an IME, the future of your recovery and your claim for compensation will come into question. While it can feel overwhelming, it is important to remember that an IME is not the end of the road, but you will need a car accident lawyer in NYC to help you see things through to the end.
If you ever find yourself caught between conflicting medical opinions in an insurance claim, let Gabriel Law help you out. As a personal injury law firm in NYC, we deal with car accident cases on a daily basis. With the right approach and support, we can help protect your rights and get you the compensation you deserve. Get in touch with us today and schedule your free consultation.
Stay in touch to get more updates & news on USA News City!
Leave a Reply