How PIP Independent Medical Evaluations Can Affect Your Claim

If you believe you have sustained injuries in a car accident, chances are you will choose to go to a hospital or doctor that is familiar to you or that you prefer. It should seem natural that you seek a treatment plan from a medical professional that you already trust or who is referred by someone you trust. No matter how competent that medical professional may be, you may find that your personal injury protection (PIP) insurance provider requests that you see a doctor of their choice during the claims process.

Reasoning for Independent Medical Evaluations

PIP insurance companies are trying to make a profit like any other business and, therefore, adjusters work to ensure the company only pays out on completely justified claims. Often, this can lead to challenges of claims or costs that you know are perfectly valid but your insurer wants additional verification.

One situation in which this is common is when an adjuster questions whether you require ongoing treatment for a car accident injury. Your doctor may have prescribed a specific treatment plan for your to follow, however, ongoing treatment means ongoing payments by the PIP insurer for your medical costs. The company may request that you undergo an independent medical evaluation (IME) with a doctor of its choice who will then report to the insurer whether your treatment is justified.

There are many potential issues that may arise with IMEs that can unfairly affect your PIP insurance benefits. For example, many doctors make significant amounts of money conducting IMEs and want to stay in the good graces of an insurance company, which may skew their opinion regarding your necessary medical costs. It is essential that you have an experienced PIP attorney protecting your rights if your insurer requests an IME.