No Fault Insurance IMEs (Physical Examinations)

No-fault insurance covers the “reasonable and necessary” medical expenses of individuals involved in a car accident in NYS. But what exactly is “reasonable and necessary” and who decides it? The answer to the first question will obviously vary from case to case, but the answer to the second question is always the same: a medical professional (such as an orthopedist, neurologist, chiropractor, acupuncturist, or physiatrist) hired and paid by your insurance carrier will examine you at a time and place of their choosing. So, the examinations are not independent medical examinations (IMEs) at all. They’re physical examinations conducted by doctors designated by the insurance company from whom they get this business. The incentive to conclude that your injuries have “resolved” is strong, as that finding allows your insurance carrier to cease paying for further treatment without breaching the terms of the insurance policy and, presumably, physicians who save your insurance carrier money are more likely to get repeat business. In my experience, approximately 75% (and I’m shooting low here) of no-fault medical examinations result in a denial of further benefits. When both you and the other vehicle involved in your accident have the same insurance carrier, which discussed here, this percentage is even higher.