PIP IME's - When a medical exam is not truly objective?

Posted Thursday, May 07, 2015 by Ed Harper

When your automobile insurance company schedules you for a medical exam, often called an IME, be aware the exam will not be conducted like a typical exam performed by your physician. The IME - referring to “independent medical exam” probably should be characterized as an “insurance medical exam” - will likely result in your medical benefits of your auto insurance policy being cut off. Under Revised Code of Washington - RCW 48.22.085(1) the Washington State Legislature requires all automobile liability insurers to offer Personal Injury Protection - called “PIP “. An insured is not required to purchase PIP, but it must be declined in writing. Basically, PIP will cover medical bills, some wage loss, funeral expenses and loss of services up to the limits found within your insurance policy.The PIP claimant must establish the treatment for injuries arose out of the use of a vehicle.Thus, what often occurs is a medical examiner, paid for his or her opinion by the insurance company, will opine the treatment stems from some other source, other than an automobile accident. As you can see below, the health care examiner can venture an opinion with a large amount of leeway. So be forewarned and forearmed going into these examinations.

Some of the questions the examiner will be asked to determine: - - Current medical condition? - - Current diagnosis? - - Is the diagnoses mentioned related to the accident? - - Are there objective findings to support the subjective complaints of the insured? - - Has the insured returned to the condition they were in prior to the accident? - - Does the insured require any additional treatment or health care? - - Please outline your recommendations? - - Please outline the basis for your opinion. - - Was there a point where treatment was no longer necessary as related to the accident in question? - - Please outline the insured’s employment at the time of the accident. - - Is the insured capable of performing their job duties as there were at the time of the accident? - - Is the insured capable of performing any job as they were prior to the time of the accident? - - If restrictions are necessary, please outline the objective basis of the restrictions. - - List the relationship any restrictions mentioned, to the accident. - - List the period of time any restrictions that you mentioned. - - Is the insured capable of performing their household duties? - - Is the insured capable of performing their essential services? - - Is the insured capable of performing their activities of daily living?

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