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Dawson and Rosenthal
Dawson and Rosenthal

San Diego Independent Medical Examinations

Claims and payments make up the world of insurance, which is meant to be your trusty safety net to keep you from falling into disrepair. Sometimes insurance goes wrong and can make the situation more complicated. To avoid this, stay on top of the claim and the situation with frequent communication.

When applying for insurance in the San Diego area, it is important that both parties be able to trust each other. As the one purchasing the insurance, you hold the power to research different companies to find the policy that works best for your needs. Insurance companies need to hold a mutual sense of trust by performing medical examinations of your current health status to make sure you are eligible for their policy. This is an independent medical examination (IME).

What Is an Independent Medical Examination?

IMEs are a requirement in the insurance industry. To determine your status and make sure you are eligible for coverage, an insurance agency will send an independent nurse to your home or tell patients they must make an appointment with a specific doctor’s office for a physical. Each situation will be different, but you can do some research on what to expect.

At its most basic, a doctor will evaluate your condition and your injuries and make a final report to the insurance company. Be aware, however, these doctors are usually retired medical professionals or other people with medical licenses whom insurers pay to make the exam go in favor of the insurance company.

Common Problems with IMEs to Prove an Insurance Claim

It is very important to understand that someone hired to prove a point performs the IMEs and that an insurance company can use an IME when you file a claim. The doctor may receive compensation to stumble across a certain finding in your exam that contradicts what your own doctor previously said. According to the Center for Justice and Democracy, IMEs are routinely tilted to benefit the insurance company by minimizing injuries or effects. If you are going through an evaluation, don’t just rely on the findings of the IME. Be sure to also receive a physical or an evaluation from your primary care provider (PCP). It may seem like a lot of time to spend at the doctor’s office, but you will be grateful you did it in the future.

IMEs and Bad Faith Insurance

The doctor may write on the report that your injuries or illness are not as severe as previously recorded, leaving a paper trail or incorrect evidence. It is important to get your hands on a copy of the IME right away and contradict any false findings with a follow-up from your own PCP. This bad faith act or insurance fraud procedure can cause a lot of damage in the wrong hands and lead to a long battle against insurance companies. It is always best to have your own PCP look at the report to confirm or deny the findings.

Why Do You Need a Lawyer?

If you suspect that your IME is incorrect and that the insurance company will use it against you in your claim, it is time to call in the professionals. A lawyer in the local San Diego area can help to weed through the paperwork and to determine the true result of an insurance claim. Don’t waste precious time and resources trying to figure it all out on your own.

Talk with an Experienced Bad Faith Attorney

Put the professionals to work who have over 50 years of experience in the industry. Talk with one of our attorneys for help with your claim today and to fight false IMEs.