No-Fault Insurance Medical Examinations (IMEs)

Many people injured in Michigan auto accidents may receive correspondence from their auto no-fault insurance company requesting an “independent medical examination.”  These are more accurately known as “insurance medical examinations.”

Common Questions Regarding No-Fault Insurance Medical Examinations

When a person receives notification of a request for an insurance medical examination, many are understandably concerned. Below are a few of the most common questions we receive regarding IMEs, as well as additional information we hope readers find helpful in answering their questions regarding these exams.

What is an insurance or “independent” medical examination?

In the Fox 17 “Know the Law” video segment below, Grand Rapids auto accident attorney, Tom Sinas, further expands on practical and legal issues regarding these requests.

First, the naming of such an exam is concerning. While auto insurance companies almost always refer to such exams as “independent medical examinations,” the fact that the insurer hand-selects the physician performing the exam is at odds with the term “independent.” Secondly, when auto insurance companies or their lawyers request an IME to be conducted by a doctor of their choosing, it is implied that the trusted and professional medical team that has been caring for the injured person is somehow not “independent.” Finally, a doctor who has never met or cared for the injured person and who is inserted into the case at the request of an insurance company is unlikely to be able to provide the kind of perspective that comes from the person’s own treating physicians.

Can a no-fault insurer request an injured person to undergo a medical exam?

Section 3151 of the No-Fault Act provides that when the mental or physical condition of a person is at issue, a no-fault insurance company can request to have the claimant undergo a “mental or physical examination by physicians.” This section does not give the insurer the right to send claimants to other types of non-physician practitioners, such as psychologists, neuropsychologists, or therapists.

What Are the Rules Pertaining to IMEs?

The specific rules pertaining to IMEs depend on the nature of the claim, as follows:

  1. Claim for Auto No-Fault PIP Benefits

    • There is a section of the Auto No-Fault Act that permits an auto insurance company to have the injured party examined. The specific statute reads as follows: “If the mental or physical condition of a person is material to a claim that has been or may be made for past or future benefits, at the request of an insurer, a person shall submit to a mental or physical examination by physicians.”  Therefore, if a no-fault insurer can request an examination of a person claiming auto no-fault PIP benefits. Yet the following rules apply to those conducting the examination.
      1. The examination must be conducted by a physician licensed to practice medicine;
      2. The licensed physician must devote at least half of their time to the clinical practice of medicine or to teaching in a medical school or in an accredited residency or clinical research program for physicians; and
      3. If care is being provided to the person to be examined by a specialist, the examining physician must specialize in the same specialty as the physician providing the care, and if the physician providing the care is board certified in the specialty, the examining physician must be board certified in that specialty.
    • Therefore, if an injured person has a claim for no-fault benefits and receives a notification for an insurance medical examination, it should be taken seriously. However, the injured party will want to closely examine the request to make sure what will be examined is permitted by law.
  2. Claim for Auto Liability (i.e., Claim Against the Person Who Caused the Car Crash)

    • The rules applicable to this type of claim differ from the rules applicable to a claim for no-fault benefits. First, if the injured person is not part of a lawsuit against the negligent driver, the auto insurer of the negligent driver has no way to require an insurance medical examination. However, when an injured party initiates a lawsuit and sues the at-fault driver, a provision in our Michigan Court rules permits one to request the other side to undergo a medical or psychological evaluation. The rule technically requires the party requesting the exam to show good cause for doing so. However, our trial courts typically permit these types of requests once a lawsuit has been filed.

What should an injured person do if requested to undergo an insurance medical exam?

Section 3152 of the No-Fault Act also states that a claimant who undergoes an insurance medical examination may request a copy of the report. Section 3153 of the Act provides that if a claimant refuses to submit to an independent medical examination, a court can issue orders that are appropriate under the circumstances, including prohibiting the claimant from introducing any evidence of his or her mental or physical condition. Therefore, claimants should never ignore a request from their insurer to appear for an independent medical examination, as an unjustified failure to appear could jeopardize the claim.

IME requests can oftentimes be confusing. As mentioned above, we always recommend taking them seriously but reading them thoroughly to make sure what will be included in the evaluation is permissible under the Michigan Auto No-Fault Act. Due to the complex nature of these notifications and language, a skilled Michigan auto accident attorney may be needed to ensure the injured party’s legal rights are protected.

Grand Rapids car crash lawyer, Tom Sinas, describes several concerning aspects of insurance medical examinations in this segment of “Know the Law” on West Michigan’s Fox 17.

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