INDEPENDENT MEDICAL EXAMS – ARE THEY REALLY INDEPENDENT?

New York State provides for no-fault payments when you are involved in an automobile accident regardless of fault. The car you are in pays for all medical bills for injuries sustained as a result of occupying a motor vehicle. The only time this varies if you occupy a truck or bus over a certain tonnage, then your own automobile insurance pays the no-fault.

The insurance company paying the no-fault has a right, pursuant to the New York State Insurance Department Rules & Regulations, to have an injured party examined by a doctor hired by the insurance company. The name for this is an independent medical examination but the last thing these physicals are, are independent.

Insurance companies complain about no-fault fraud, which does exist. However, the mechanism to have an injured party examined is a farce. In 36 years of doing personal injury work for injured parties, I have seen three “independent medical reports” finding something wrong with the injured party. Just the way insurance companies complain that medical providers have no-fault mills, medical facilities that treat the injured person with multiple medical treatment (physical therapy, chiropractic treatment, physiatrists, neurologists and orthopedics), so does the insurance companies have mills for “independent medical examinations”. These are doctors who work for the insurance company and their sole purpose is to cut off insurance payments (no-fault benefits). These insurance company mills of no-fault doctors never find anything wrong with the injured person (regardless of the injury). The “independent medical examinations” are held by the same doctors over and over.

These doctors literally have offices with a number of examining tables behind curtains and at any given time the injured party is put in one of these exam rooms (with many others in the next curtained area), and the doctor goes in and the physical examination takes anywhere from 5 – 10 minutes. From this cursory exam, they write a report (they all look the same) finding the injured party no longer needs medical treatment. The no-fault insurance company then takes these reports and issue a Denial of No-Fault benefits. There is no connection between the real injury and the denial.

This law firm has had no-fault exams on patients who require surgery yet pursuant to the insurance company doctor, they cut off no-fault benefits. This leaves the patient without medical benefits. If the injured party has no medical insurance, they then must pay their medical bills out of their own pocket. If the injured party has private health insurance, they must pay the medical bills if no-fault denies.

The no-fault physical exams serve two purposes for the insurance companies. One, they stop paying the medical benefits and two; they stop the injured party from proving their injuries in a lawsuit against the other automobile.

Under the no-fault insurance law there are categories of injuries that an injured party must fit in before they can sue for personal injuries. For example, you can sue if you sustain a fracture, scar, death or dismemberment. Under these categories there are three sections that involve all parts of your body. A significant loss of use of a body organ or member or a permanent consequential loss of use of a body organ or member and the third category is to be disabled from normal activities for 90 days (three months) out of 180 days (six months) following your accident.

When the no-fault doctor cuts you off, it affects the three categories under which you can bring a personal injury lawsuit. The no-fault insurance company tries to stop treatment before the ninety days after the accident to eliminate three of the categories you can sue a third party under. With all our personal injury clients we attempt to postpone any physical by an insurance company doctor until after ninety days of treatment.

The law must be changed to stop this abuse of the no-fault law. The Legislature should pass laws to prohibit biased exams by an insurance company doctor to stop your treatment before ninety days. The Legislature should give the injured party at least ninety days to treat before permitting an insurance company doctor to stop payment.

If you, or someone you know, have been involved in a motor vehicle accident, we request that you contact our office so that we can help take you through all of the necessary steps required to obtain your no-fault benefits and, eventually file a lawsuit, if necessary, against the other vehicle. You can reach us at (914) 288-0800. We look forward to helping you through this difficult time and prevent you from becoming overwhelmed in the process.