Do you need to go to a No-Fault (IME) Independent Medical Exam?

What is a No-Fault Independent Medical Exam or IME?  When you have been injured in a car accident, your medical bills and other benefits are paid by the no-fault insurance company. The no-fault insurance company has the right to have you attend a physical exam conducted by a doctor paid by the no-fault insurance company. This examination is called an Independent Medical Exam or IME. They use the term independent because the doctors are employed by a third-party company that has nothing to do with the insurance company. However, the exam is not really independent because the independent company relies upon the insurance company for work and the doctor relies upon the independent company for work. Consequently, no fault doctors have a lot of pressure to deny benefits and we call them a no-fault exam.

Do I need to attend the Independent Medical Exam (IME)? If you live in the Bronx or Manhattan, the answer is yes.  You need to attend every no-fault physical exam that is requested.  If you live anywhere in New York and you fail to attend a no-fault IME, you will be denied further no-fault benefits because of your failure to attend the physical exam. However, a decision on March 17, 2011 in the Appellate Division, First Department of the New York State Supreme Court (Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC 2011 NY Slip Op 01948) held that the failure to attend a no-fault IME exam will void the insurance policy retroactively back to the date of the accident. The First Department affects the Bronx and New York County (Manhattan).

This means that if you have a fractured hip because of a car accident and have been seeing only an orthopedic surgeon, the no-fault insurance company could get tricky and send you a letter ordering you to appear for an examination with a dentist. You might think “I don’t have a dental injury and I never saw a dentist, so I don’t need to go to the physical”, but because of the recent decision, you now need to go to all physicals regardless of the medical specialty or all of your benefits including payment for the ambulance, hospital medical treatment, lost wages and other benefits can be immediately canceled and the insurance company may even seek to recover everything they already paid out.

My recommendation is that even if you live in a county other than the Bronx, you should attend all no-fault independent medical examinations.