You get a letter from the car insurance company saying you must attend an “independent medical examination.” What do you do? What are your rights? Although these reviews may be called IMEs, they are usually anything but independent, medical in nature, or a true evaluation of an individual’s injuries, impairments and disabilities following a Michigan car crash.
What is an Independent Medical Evaluation?
An IME is when the insurance carrier requires you to attend a doctor’s appointment to get their own “evaluation” of the injuries and prognosis for an injured person. They are very common after Michigan car accidents. The doctor is selected and paid by the insurance carrier. The doctor is not hired to make the patient better or to even provide any medical advice.
Instead, the doctor is paid do an “evaluation” and write a report. The insurance company can then use the report to limit benefits or outright terminate future benefits based on the hired doctor’s recommendations and opinions. A 10-minute examination by one of these doctors can result in the insurance company stopping the payment of lost wages, medical bills and other no-fault PIP benefits.
For auto accidents, IMEs are allowed under the insurance contract and permitted by Michigan law, specifically MCR 2.311(A), and MCL 500.3151.
What Happens When the Car Insurance Company Stops Paying Medical Benefits?
Getting cut-off or having benefits terminated is a very scary event. Insurance companies are given a lot of freedom under the law to send their claimants to multiple IMEs. They then use the reports to stop paying wages, medical bills, prescriptions, medical supplies and other items. The next step is to file a lawsuit in court against the auto carrier who refuses to pay. A skilled Michigan car accident lawyer will help you obtain the benefits you deserve.
However, the insurance carrier – such as State Farm, Progressive or Allstate – are only responsible for paying benefits that are incurred. This means they do not have to pay for future benefits. Instead, they must only pay for medical treatment that has already been completed.
As such, many doctors won’t treat patients who have been cut-off. They are afraid they will not get paid. When this happens, it’s important to find a doctor who will still agree to treat you for your injuries on a “lien.” This means they will treat you without initially getting paid for their services, but will obtain payment upon the settlement of the case.
What are the Rules for IMEs in Michigan?
Under Michigan law, there are not too many rules that safeguard patients from the opinions of these hired guns. In fact, MCR 2.311 permits insurance companies to ask the court to order injured plaintiffs to attend IMEs.
In addition, under MCL 500.3151, when a motor vehicle accident occurs, injured persons making a claim for medical benefits must submit to an IME if the insurance company requests the exam. The statute reads:
(1) If the mental or physical condition of a person is material to a claim that has been or may be made for past or future personal protection insurance benefits, at the request of an insurer the person shall submit to mental or physical examination by physicians.
Although the attorneys for the plaintiffs can attempt to set limitations on the scope and number of IMEs, for the most part insurance companies are granted wide latitude in making their claimants attend these “exams.”
There is one limitation about IMEs that was added when the Michigan no-fault law was changed in 2019. A person doing an IME must be a licensed physician and during the year immediately preceding the IME the examining physician must have devoted a majority of his or her professional time to either an active clinical practice of medicine or teaching medical school students or instructing a clinical research program.
In addition, if a person is seeing a specialist – like an orthopedic surgeon or a pain management doctor – the IME doctor must also specialize in the same specialty as the physician providing the care.
This change was enacted to do away with hired guns who no longer practiced medicine or saw patients, but still were employed by insurance companies to cut-off claimants.
Can a Lawyer Get the IME’s Financial Records?
Recently, the Michigan Court of Appeals ruled that doctors hired by the insurance company cannot hide behind the money they make for doing these forensic examinations. This is a major change.
For years, doctors in all specialties would perform IMEs, but plaintiff lawyers were not able to obtain the financial documents of these doctors to show a jury how much money they were making doing work for insurance companies. Instead, the parties had to rely on what a doctor said during his or her deposition about their compensation. This made it extremely difficult to prove bias.
There are numerous DMEs (defense medical evaluators) in Michigan who rake in hundreds of thousands of dollars per year, even millions, performing evaluations and writing template reports to give the insurance companies what they want – a termination of future benefits.
However, in Warda v. Farm Bureau General Insurance Company, (docket no. 362690, unpublished 1/25/2024), the Court held financial documentation, in particular W2s and Form 1099s were discoverable and must be turned over to plaintiff’s counsel if requested. In this case, a man suffered injuries in a car crash in Michigan. The plaintiff treated with a number of doctors for his injuries. Farm Bureau hired no less than four (4) IME doctors to perform evaluations on Mr. Warda about his injuries from the wreck.
Mr. Warda’s counsel issued subpoenas to the individuals who performed the IMEs, in particular requesting tax returns. The trial judge ruled that Mr. Warda’s counsel could not obtain the physicians’ entire tax return, but could obtain the doctors’ Form 1099s showing income earned conducting IMEs from 2019 through 2021. In addition, Mr. Warda could also obtain the Form W-2s for those years to prove these doctors were devoting more than 50% of their time to treating actual patients or instructing medical students.
The doctors appealed this ruling to the Michigan Court of Appeals, but the Court affirmed or upheld the trial judge’s ruling.
Certain Tax Records for IMEs are Discoverable
The reasons given by the Court for allowing disclosure of these tax documents were simple. First, the tax documents are relevant to a jury to show bias. A jury should be able to find out that Dr. Smith made $500,000 last year doing IMEs for insurance companies. A jury should understand if the IME doctor has a history of doing work for the insurance company. The jury can use this piece of information to weigh the doctor’s credibility.
In addition, it is important for a jury to understand the percentage of total income earned by conducting IMEs. And the only way to get this information is by reviewing the doctor’s W-2 income. The Court stated it succinctly:
An individual could be more prone to bias if a significant and greater portion of that person’s income is dependent on conducting IMEs. Thus, a person whose IME income constitutes only 10% of their total income is quite different than someone deriving 50% of their income from conducting IMEs.
Last, the Court also ruled tax information helps prove whether the IME doctor meets the requirements set forth in MCL 500.3151(2)(b). As mentioned above, the IME doctor must have devoted a majority of his or her professional time in active clinical practice or teaching medical school students. A doctor’s W-2s and 1099s can help the parties discover whether the doctor meets these requirements.
Did the Insurance Company Send You To an IME? Call Our Office TodayThe Lee Steinberg Law Firm has been serving injured Michigan residents for almost 50 years. We know all the tricks insurance companies try to pull after a car accident. We have obtained hundreds of millions for our clients. Our firm is aggressive in getting our clients the money they are owed. Call us for a free consultation at 1-800-LEE-FREE (1-800-533-3733).
