One of the most powerful tools the insurance industry uses to defeat your claim is the Compulsory Medical Examination (formerly, but more commonly, known as the Independent Medical Exam (IME)).
In the pre-litigation phase, your own insurance company will be the one to send you to this doctor, who will almost always deem you healthy (a CME that is paid for by your own insurance company is called a “first-party” CME). Once this CME doctor says you are unhurt from the accident, your insurance company is allowed to cut you off from the medical benefits that would otherwise be available under your insurance coverage.
Once a lawsuit is filed, your own insurance company or the other side’s insurance company will pay to send you to one of these doctors for the purpose of having that doctor testify at trial that you are healthy and unhurt from this accident. When the other side’s insurance company sends you for a CME, it’s called a “third-party” CME.
The CME is an area where insurance companies have shown how unethical they can be. Most insurance companies have a very small group of doctors who are “reliable enough” to always state that the injured person is either not injured or the injury is related to some other event, such as aging or a previous, remote incident. The insurance company tries to diminish or deflect the responsibility of the wrongdoer in the particular case to make it seem like aging or a prior incident is the cause of the injury so the insurance company does not have to pay the injured person.
If the insurance company schedules you for a CME appointment, you need to be aware of the doctor’s role at that appointment. His purpose is typically to decrease or eliminate the need for the insurance company to pay you for your injury by finding another cause of your injury. Although he may seem really sweet and caring, the CME doctor is not your friend and is not there to help you. You should have the same demeanor during your CME examination as you would during a deposition or at trial, which means not to joke or make light of the situation. You are there for a serious reason. However, at the same time, you need to be respectful and likable.
You should schedule an appointment with your own physician on the same exact day as your CME appointment. The purpose is so that your own doctor’s records from your visit that same day may help you contradict some of the untruthful or inaccurate findings that the CME doctor will almost surely put in his report. Many times, we have read a CME report from a doctor who states our client was pain-free and had perfect range of motion on the day of the appointment, while our client’s own doctor will state that our client was in pain and had very limited range of motion on the same exact day. This is helpful ammunition that your lawyer can use to fight back against the insurance company.
Another tactic you can use to fight back against the insurance company is to ask your own doctor to write a letter to the CME doctor ahead of time, outlining his opinions of your injury and informing the CME doctor of his treatment plan for you. Sometimes, a CME doctor who is presented with this information from one of his peers is inclined to be fairer to you during his examination. Your doctor should be willing to take the time to write such a letter for you because if he does not and the CME doctor deems you healthy and unhurt from the accident, your doctor will no longer get paid by your insurance company (in a first-party CME scenario).
If a first-party CME is completed and you are cut off from your insurance benefits, you should contact a PIP lawyer, who will fight and possibly sue your insurance company to try to reinstate your benefits. If he isn’t successful, he won’t get paid. If he is successful, he will be paid by the insurance company and not by you. If your personal injury lawyer doesn’t do these “PIP suits,” they can refer you to a quality PIP lawyer who does.
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