Someone injured in a Florida car accident can choose the doctors she or he wishes – but not all of them. Their car insurance company can force them to go see one of their doctors by compelling an IME (Independent Medical Examination). It should be called a CME (Compulsory Medical Examination) because there is nothing independent about these exams and the insured must go or they lose insurance benefits they paid for.
Under Florida’s No-Fault Statute, the injured person’s car insurance has to pay personal injury protection benefits up to $10,000.00. Personal Injury Protection (PIP) benefits supposed to pay all medical expenses that are reasonable, necessary and related to a car accident. To get around payment, the insurance company sends their insured to one of their doctors through an IME who typically declare that no more treatment is reasonable, necessary or related to the car accident. As a result, the injured party’s insurance company quits paying PIP benefits and the insured is responsible for the medical expenses unless a lawsuit is filed.
The present law for this IME or CME
The present law found in Florida Statute Sec 627.736(7) states:
Whenever the mental or physical condition of an injured person covered by personal injury protection is material to any claim that has been or may be made for past or future personal injury protection insurance benefits, such person shall, upon the request of an insurer, submit to mental or physical examination by a physician or physicians.
As you can see, the law states “shall” and not “may” making this examination compulsory.
Where must the IME (CME) be performed?
The law states:
Such examination shall be conducted within the municipality where the insured is receiving treatment, or in a location reasonably accessible to the insured, which, for purposes of this paragraph, means any location within the municipality in which the insured resides, or any location within 10 miles by road of the insured’s residence, provided such location is within the county in which the insured resides.
Why would the insurance company want to set an IME (CME)?
The law provides the reasons:
An insurer may not withdraw payment of a treating physician without the consent of the injured person covered by the personal injury protection, unless the insurer first obtains a valid report by a Florida physician licensed under the same chapter as the treating physician whose treatment authorization is sought to be withdrawn, stating that treatment was not reasonable, related, or necessary.
This means the insurance company has to continue paying for treatment that the treating doctor says is reasonable, related and necessary until one of their doctors provides a report that contradicts the treating doctor.
So, if attending the IME (CME) is likely going to result in the denial of the PIP benefits, why not just not go so the insurance company doesn’t get the necessary report?
Well, the law does not allow your refusal to attend an IME (CME). The law states:
If a person unreasonably refuses to submit to or fails to appear at an examination, the personal injury protection carrier is no longer liable for subsequent personal injury protection benefits. An insured’s refusal to submit to or failure to appear at two examinations raises a rebuttable presumption that the insured’s refusal or failure was unreasonable.
What can be done after the PIP carrier cuts off benefits because of the IME (CME) report?
If the injured person and their treating doctor believe that future care is reasonable, necessary and related to the car accident (despite what the doctor who saw the patient one time for less than 10 minutes says), either the injured person or the medical provider (depending on whether they have an assignment of benefits) can file a PIP lawsuit and fight to get the remaining PIP benefits. If the injured person or doctor win the lawsuit, the insurance company will have to pay attorneys’ fees and costs.
As you can see, after a Florida car accident, the law makes these IMEs compulsory because it states that the insured shall attend and provides repercussions if the insured fails to attend. If you are injured in a car accident and your insurance company schedules an IME (CME), you must attend. Take good notes of what the doctor did in terms of examination; be 100% honest about your symptoms and pain; and document the times the doctor spent actually examining you. Provide these notes to your attorney. Also, it is a good idea to see your treating doctor the same day of the IME appointment, but after the appointment so he or she can document how her or his findings on a true examination.
Knowing the law after a car accident can prevent you from losing insurance benefits because of an unreasonable refusal to see one of your insurance company’s appointed doctors.
Personal Injury Attorney Matthew Noyes represents those injured in car accidents, motorcycle crashes, bicycle accidents, pedestrian accidents and other types of personal injury matters. He is a named partner at the Tampa Bay law firm of Perenich Caulfield Avril Noyes – one of the oldest personal injury law firms in Pinellas County. Call Attorney Matthew Noyes now at 727-796-8282 or complete the form on this page or simply click here to schedule a free case consultation.