By Tom Kirvan
Legal News
Nicholas Andrews, a partner at Birmingham-based Liss & Andrews, P.C., is fresh from a year serving as president of the Michigan Association for Justice, an organization of more than 1,300 trial lawyers that is in “relentless pursuit of a fair and effective legal system.”
Such as one where insurance companies don’t use Independent Medical Examinations (IMEs) to “minimize payouts by having an insurer-selected doctor review your file” in cases where accident victims have suffered injuries requiring medical care and fair compensation for the damages incurred, according to Andrews.
“All too often, insurance companies use Independent Medical Examinations as a roadblock to paying benefits to the insured or to delay the payment of their claim,” said Andrews, who for more than two decades has represented victims of catastrophic injuries and insurance bad faith. “In effect, they use IMEs as a means of delaying or denying benefits completely.”
Andrews said the tactics have become more commonplace since Michigan’s No-Fault Act underwent sweeping changes in 2019. The revisions, according to Andrews, were sold as a way to lower auto insurance premiums but the “real-world
results have been uneven,” creating unintended consequences such as reduced benefits and new bureaucratic hurdles for those injured in motor vehicle accidents.
Section 3151 of the Michigan’s No-Fault Act, which took effect in 2020, grants auto insurers the statutory right to request that a claimant undergo an IME whenever their physical or mental condition is material to a Personal Injury Protection (PIP) claim, Andrews indicated.
“Under this Section 3151 provision, individuals must submit to the exam or the insurance company can suspend or deny benefits,” Andrews said. “However, the examination must be performed by a licensed physician – either an M.D. (Doctor of Medicine) or a D.O. (Doctor of Osteopathic Medicine).
“The statute requires strict ‘qualification-matching’ requirement on the examining physician to prevent biased evaluations,” Andrews noted. “In other words, the examining physician must specialize in the same medical specialty as the claimant’s treating physician. If the treating physician is board-certified in that specialty, then the insurance company’s physician must hold the same board certification. The examination must be performed by a licensed medical physician.
Insurance companies cannot mandate exams by non-physician practitioners like psychologists or neuropsychologists.”
Andrews also noted that claimants are not required to comply with a request for a dental or chiropractic visit, since neither one is defined as a medical doctor under Michigan law.
“In many cases, insurance companies use these exams as a tactic to delay or deny attendant care benefits,” Andrews declared. “They also often push for additional exams that are not required by law. These exams, which are supposed to be conducted by an independent medical practitioner, tend to be anything but ‘independent,’ as the doctor is paid by and relies on the insurer for ongoing referrals.”
Andrews said that the fundamental ethical and legal dynamics of IMEs center on an inherent tension – the evaluating physician is hired and paid by a third party (such as an insurer, an employer, or a defense attorney) to assess the medical condition of a claimant, yet they must still abide by specific professional conduct and legal mandates.
“There is an inherent conflict of interest,” Andrews said of how the IME process is structured.
Missing or refusing to attend a mandated IME can result in the automatic denial of a claim, according to Andrews, noting that claimants are generally required to participate if it is outlined in the policy’s cooperation clause.
“Which is why we have a standard practice of attending every medical exam involving a client, even if a lawsuit has not been filed,” said Andrews. “For our clients, this is the best way to protect their legal interests and to make sure that the exam is conducted professionally and is not just a fishing expedition designed to minimize the injuries they sustained.”
Once the exam has taken place and a report has been submitted by the examiner, claimants are entitled to review the resulting report for possible inaccuracies, according to Andrews.
“The key point is that claimants have to ask for the report, as it is not given to them automatically,” said Andrews. “Which is another reason why we attend all medical exams, which provides us with firsthand knowledge of what took place during the exam and what questions were asked by the physician.”
The value of having an attorney present during an exam became recently apparent when a longstanding client of Liss & Andrews was ordered to undergo an IME, according to Andrews.
“Our client is a man in his 30s who suffered a severe brain injury as a kid and has been receiving attendant care benefits for years,” Andrews explained. “He is among the ‘walking wounded,’ people who are dealing with the long-term consequences of a severe brain injury.
“Because we were there at the exam and had documented our client’s functional limitations prior to the exam, the resulting report was an honest and accurate portrayal of his medical condition and the injuries that he had suffered,” Andrews indicated. “In this case, I think our presence there really mattered in how the report was written.”
Legal News
Nicholas Andrews, a partner at Birmingham-based Liss & Andrews, P.C., is fresh from a year serving as president of the Michigan Association for Justice, an organization of more than 1,300 trial lawyers that is in “relentless pursuit of a fair and effective legal system.”
Such as one where insurance companies don’t use Independent Medical Examinations (IMEs) to “minimize payouts by having an insurer-selected doctor review your file” in cases where accident victims have suffered injuries requiring medical care and fair compensation for the damages incurred, according to Andrews.
“All too often, insurance companies use Independent Medical Examinations as a roadblock to paying benefits to the insured or to delay the payment of their claim,” said Andrews, who for more than two decades has represented victims of catastrophic injuries and insurance bad faith. “In effect, they use IMEs as a means of delaying or denying benefits completely.”
Andrews said the tactics have become more commonplace since Michigan’s No-Fault Act underwent sweeping changes in 2019. The revisions, according to Andrews, were sold as a way to lower auto insurance premiums but the “real-world
results have been uneven,” creating unintended consequences such as reduced benefits and new bureaucratic hurdles for those injured in motor vehicle accidents.
Section 3151 of the Michigan’s No-Fault Act, which took effect in 2020, grants auto insurers the statutory right to request that a claimant undergo an IME whenever their physical or mental condition is material to a Personal Injury Protection (PIP) claim, Andrews indicated.
“Under this Section 3151 provision, individuals must submit to the exam or the insurance company can suspend or deny benefits,” Andrews said. “However, the examination must be performed by a licensed physician – either an M.D. (Doctor of Medicine) or a D.O. (Doctor of Osteopathic Medicine).
“The statute requires strict ‘qualification-matching’ requirement on the examining physician to prevent biased evaluations,” Andrews noted. “In other words, the examining physician must specialize in the same medical specialty as the claimant’s treating physician. If the treating physician is board-certified in that specialty, then the insurance company’s physician must hold the same board certification. The examination must be performed by a licensed medical physician.
Insurance companies cannot mandate exams by non-physician practitioners like psychologists or neuropsychologists.”
Andrews also noted that claimants are not required to comply with a request for a dental or chiropractic visit, since neither one is defined as a medical doctor under Michigan law.
“In many cases, insurance companies use these exams as a tactic to delay or deny attendant care benefits,” Andrews declared. “They also often push for additional exams that are not required by law. These exams, which are supposed to be conducted by an independent medical practitioner, tend to be anything but ‘independent,’ as the doctor is paid by and relies on the insurer for ongoing referrals.”
Andrews said that the fundamental ethical and legal dynamics of IMEs center on an inherent tension – the evaluating physician is hired and paid by a third party (such as an insurer, an employer, or a defense attorney) to assess the medical condition of a claimant, yet they must still abide by specific professional conduct and legal mandates.
“There is an inherent conflict of interest,” Andrews said of how the IME process is structured.
Missing or refusing to attend a mandated IME can result in the automatic denial of a claim, according to Andrews, noting that claimants are generally required to participate if it is outlined in the policy’s cooperation clause.
“Which is why we have a standard practice of attending every medical exam involving a client, even if a lawsuit has not been filed,” said Andrews. “For our clients, this is the best way to protect their legal interests and to make sure that the exam is conducted professionally and is not just a fishing expedition designed to minimize the injuries they sustained.”
Once the exam has taken place and a report has been submitted by the examiner, claimants are entitled to review the resulting report for possible inaccuracies, according to Andrews.
“The key point is that claimants have to ask for the report, as it is not given to them automatically,” said Andrews. “Which is another reason why we attend all medical exams, which provides us with firsthand knowledge of what took place during the exam and what questions were asked by the physician.”
The value of having an attorney present during an exam became recently apparent when a longstanding client of Liss & Andrews was ordered to undergo an IME, according to Andrews.
“Our client is a man in his 30s who suffered a severe brain injury as a kid and has been receiving attendant care benefits for years,” Andrews explained. “He is among the ‘walking wounded,’ people who are dealing with the long-term consequences of a severe brain injury.
“Because we were there at the exam and had documented our client’s functional limitations prior to the exam, the resulting report was an honest and accurate portrayal of his medical condition and the injuries that he had suffered,” Andrews indicated. “In this case, I think our presence there really mattered in how the report was written.”
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