Do I Have to Go to the Independent Medical Exam (IME) the Insurer Wants?

You are in the middle of your car accident claim, and you’ve been diligently following your doctor’s treatment plan. Then, you receive a formal letter from the insurance company. It informs you that they have scheduled an appointment for you with another doctor for an “Independent Medical Examination,” or IME.

The letter makes it sound like a routine second opinion, but it can feel invasive and stressful. Do you really have to go? Do you have to let a doctor chosen and paid for by the insurance company examine you? And how “independent” is this exam, really?

This is a critical juncture in your claim. An IME is a powerful tool used by insurance companies to gain leverage in a settlement negotiation. Understanding what it is, what your obligations are, and how to prepare for it is essential to protecting the value of your claim.

Useful Information for You: In a Nutshell

• What It Is: An IME is a medical examination conducted by a doctor who is chosen and paid by the insurance company to provide a “second opinion” on your injuries.
• It is NOT Independent: The term “independent” is misleading. The doctor has a financial relationship with the insurance company, and their reports often favor the insurer’s position. It is an adversarial exam.
• Do You Have to Go? It Depends. If the request is from YOUR own insurance company for a PIP or UIM claim, your policy’s cooperation clause likely requires you to attend. If it’s a request from the AT-FAULT driver’s insurer, you are generally not obligated to go unless a lawsuit has been filed and the exam is ordered by the court.
• Preparation is Key: You must be prepared for the exam. Be completely honest about your symptoms, do not exaggerate, but also do not downplay your pain.
• You Should Have a Lawyer: The request for an IME is a clear signal that the insurance company is challenging the severity of your injuries. This is the single most important time to have an attorney on your side.

The Truth About the “Independent” Medical Exam

The first thing to understand is that the IME is not a typical doctor’s visit. The IME doctor is not there to treat you. Their one and only job is to provide a report to the insurance company that answers specific questions, such as:

• Are the claimant’s injuries as severe as they say they are?
• Was the medical treatment they received actually necessary?
• Are the injuries related to the car accident, or are they from a pre-existing condition?
• Has the claimant reached Maximum Medical Improvement (MMI)?

These doctors are hired repeatedly by insurance companies, and they know that their future business depends on producing reports that help the insurer devalue or deny claims.

Are You Legally Obligated to Attend?

This is the key question, and the answer depends on who is asking.

1. A Request from YOUR OWN Insurance Company (for a PIP or UIM claim):

Yes, you are almost certainly required to go. Your own insurance policy is a contract that contains a “cooperation clause.” This clause requires you to cooperate with their reasonable investigation of your claim, which includes attending an IME. An unreasonable refusal to attend could give them grounds to deny your PIP or UIM benefits.

2. A Request from the AT-FAULT Driver’s Insurance Company:

No, not automatically. You are not in a contract with the other driver’s insurer. Before a lawsuit is filed, you are generally not obligated to submit to an examination by their hand-picked doctor. However, if you file a lawsuit, the defense has the right to request an IME under the court’s rules of civil procedure, and a judge will almost always grant it.

How to Prepare for and Handle Your IME

Because this is an adversarial exam, you must be careful and prepared.

• Be Punctual and Polite: Show up on time and be courteous to the doctor and their staff.
• Be Honest: Do not exaggerate your symptoms. IME doctors are experts at spotting inconsistencies, and any exaggeration will destroy your credibility.
• Be Thorough and Consistent: At the same time, do not downplay your pain. Be detailed and specific about how the injuries affect your daily life. The symptoms you describe to the IME doctor should be consistent with what you have been telling your own doctors.
• Don’t Volunteer Information: Answer the questions asked, but do not offer extra information about your life, hobbies, or the accident itself. Keep your answers focused on your medical condition.
• The Exam is “Live” From the Moment You Arrive: Be aware that you are being observed from the moment you get out of your car in the parking lot. The doctor’s staff will note how you walk, sit, stand, and fill out paperwork.

The request for an IME is a clear sign that your case is becoming more complex and adversarial. The insurance company is actively looking for a reason to fight your claim. You should not have to go through this process alone.

If you have been asked to attend an IME for your car accident claim in the Tacoma area, it is crucial to get legal advice immediately. Search the Car Accident Lawyer Directory Tacoma to find and compare trusted local attorneys who can help you prepare for the exam, review the IME doctor’s report for inaccuracies, and fight back against an unfair assessment.

References

• Washington State Office of the Insurance Commissioner (OIC) – Independent medical exams (IMEs):The official consumer guide from the OIC explaining what an IME is in the context of a PIP claim and a policyholder’s rights and responsibilities.https://www.insurance.wa.gov/independent-medical-exams-imes
• Washington State Court Rules – CR 35 – Physical and Mental Examination of Persons:The official court rule that governs how a party in a lawsuit can request a physical or mental examination of the other party.https://www.courts.wa.gov/court_rules/?fa=court_rules.display&group=sup&set=CR&ruleid=supcr35
• Washington Administrative Code (WAC 284-30-395) – Standards for prompt, fair and equitable settlements applicable to automobile insurance:The state regulations governing fair claims practices, which can be relevant if an IME is being used in an unfair manner.https://app.leg.wa.gov/WAC/default.aspx?cite=284-30-395