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No-Fault Insurance Medical Examinations (IMEs)

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

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

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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 practitioners, such as psychologists or neuropsychologists. Moreover, the right to conduct such an examination [often referred to as an “independent medical examination” (IME)] is subject to a general requirement of reasonableness.

What types of doctors can perform a medical exam?

The 2019 no-fault reform legislation adopts new limitations on the right of insurance companies to conduct an independent medical examination. The new legislation requires that medical evaluations performed at the request of insurance companies be performed by physicians with specialization similar to those of the injured person’s treating physician. Specifically, the new statute states, “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.” [§3151(2)(a)].

In this video with Fox 17 Know the Law, Grand Rapids car crash lawyer, Tom Sinas, describes these changes. Under the reformed law, certain physician requirements must be met, as well as specialization specifics.

The new legislation also provides that in all cases, an examining physician, during the year prior to the medical evaluation, must have devoted a majority of his or her time to the act of clinical practice of medicine or to teaching in a medical school or in an accredited residency or clinical research program for physicians. [See §3151(2)(b)]  These new general qualification and specialization rules went into effect on June 11, 2019.

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.