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Explaining the Use of an IME 

https://zalma.com/blog

Medical examiners have established their own codes of ethics with regard  to an IME and are obligated by those codes to report their findings  fairly and accurately. The American Board of Independent Medical  Examiners has published the following Code of Ethics:  Physicians shall:  Be honest in all communications. Respect the rights of the examinees and other participants, and treat  these individuals with dignity and respect.  An independent medical examiner has a contractual relationship with the  entity that employs them but no preexisting relationship with the  subject of the examination. And this contractual relationship is often  independent of, if not adverse to, the subject\'s relationship with the  examiner\'s employer. To impose a categorical duty of care running from  the independent medical examiner to the subject would put the examiner  in an untenable position, if not create an outright conflict of  interest. [Kirk v. Anderson (Utah Supreme Court, 2021)]  The adjuster who follows the rules profiled by the American Board of  Independent Medical Examiners, which are similar to those posited by the  International Association of Special Investigation Units (IASIU),  should receive appropriate independent medical advice.  

The adjuster (and the SIU fraud investigator) must be dedicated to:  Promoting a coordinated effort within the industry to combat insurance  fraud; providing education and training for insurance investigators;  developing greater awareness of the insurance fraud problem; encouraging  high professional standards of conduct among insurance investigators;  and supporting legislation that acts as a deterrent to the crime of  insurance fraud.  When an IME is retained the insurer should advise the IME of his  obligations in writing, in the following manner:  You have been retained by the ABC Insurance Company to conduct an  independent medical examination of the claimant and report to me,  concerning the injuries sustained, the present condition, your prognosis  and your evaluation of any continuing treatment needed by the claimant.  

To assist you in that regard we enclose as complete as possible all of  the medical records of the claimant of which we are aware.  The purpose of your examination is to thoroughly review all relevant  facts within your field of expertise so we may determine whether the  injuries reported by the claimant captioned above was caused by the  accident and, if so, the extent of the injuries so that we may properly  evaluate his claim against our insured. We expect your examination to  provide the Company with sufficient facts to assist it in its obligation  to make a decision with regard to the claim. 

 \\xa9 2021 \\u2013 Barry Zalma  Barry Zalma, Esq., CFE, now limits his practice to service as an  insurance consultant specializing in insurance coverage, insurance  claims handling, insurance bad faith and insurance fraud almost equally  for insurers and policyholders.  He also serves as an arbitrator or mediator for insurance related  disputes. He practiced law in California for more than 44 years as an  insurance coverage and claims handling lawyer and more than 54 years in  the insurance business. 

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