What happens if I don’t attend an independent medical exam that the insurance carrier schedules for me?

Under Florida Statue, an insurer can mandate an independent medical examination for mental or physical conditions whenever the condition is “material” to any benefit claims. Because the insurer has a right under the no-fault (PIP) law to obtain an IME, if the insured (whether intentionally or unintentionally) misses an IME the insurer has a right to deny benefits, barring certain exceptions. Some attorneys may advise you to not attend the examination, but this constitutes a material breach to the contract you entered into with the insurance carrier and may release them from their obligation to pay PIP. Be mindful that even though a written report from a physician licensed under the same statute is required to withdraw, reduce, or deny further medical benefits, it is not required to reduce or contest a physician’s billed charges because of reasonableness or necessity. Derius v. Allstate Indemnity Co., 837 So.2d 406 (Fla. 2003). Moreover, if a plaintiff does not attend an IME, the insurer may be relieved from paying medical bills incurred before the exam but received after benefits have been terminated. U.S. Security Insurance Co v. Silva, 693 So.2d 593 (Fla. 3d DCA 1997). However, failure to attend the exam doesn’t automatically eliminate the insurer’s duty to pay because the insurance contract might have some provisions in it or the exam may have been schedule in a distant location from the plaintiff’s residence. Make sure your Palm Beach County accident attorney is aware of the text of your entire insurance contract before you attend the insurance carrier’s IME.
Remember that you are allowed to take a witness with you into the medical exam. This is suggested for every IME requested by the insurer. Don’t forget that the physician is a hired gun by the opposing side to try to conclude that you are not injured or are not in pain. Be sure to let the physician know any pain you are feeling and if you are uncomfortable in any way. Don’t be shy about letting they physician know the extent of your pain. Also, be sure you are completely honest with the physician but do not provide them with more information than they need because this might be used against you later.
Many times, the insurance carrier has their priority physicians they like to deal with, and they will be sending you to one of those. This is almost like a dependable pipeline of business for the physician, so they may have an incentive to find results favorable to the insurance company. There are ways that your Palm Beach County accident attorney can discover this type of information prior to trial. However, it is in your best interest to be knowledgeable and put yourself in the best position to make the insurance company hold to their end of the bargain.