Under Michigan Compiled Laws § 500.3151, an insurance company has the right to request an Independent Medical Exam (IME), also referred to as a Defense Medical Examination (DME), after you file a Personal Injury Protection (PIP) claim. However, the right to request a DME or IME does not always mean that you MUST attend the exam. The findings from a DME can significantly impact your eligibility for benefits. To protect your rights, you should know what the exam entails, what your rights are, and how to best protect them.
What Are DMEs and When Are They Requested?
A DME is a medical evaluation by a doctor of the insurance company’s choice, at their expense with the goal of denying or limiting your eligibility for benefits. They have multiple different purposes, including:
- Obtaining an insurance favored opinion on your injuries and overall condition
- Verifying the necessity of the medical treatment you’re receiving
- Verifying your injuries and treatment are tied to the car accident
- Verifying whether or not you can return to work, and in what capacity
Due to somewhat recent changes in the law, DME doctors must meet certain legal standards. If your treating physician is a board-certified specialist, the DME examiner must be board-certified in the same specialty. They must also have devoted the prior year of their career to clinical practice or teaching at an accredited medical school.
Do I Have To Attend a DME in Michigan?
Generally, you should attend a DME if your insurance company requests it. Insurers may deny PIP benefits if a claimant refuses to go to the exam; however, since the No Fault Statute does not require DME attendance in order to receive benefits; Courts have held that refusal to attend a DME in and of itself is not an absolute bar to receiving benefits. This is case specific.
However, Michigan law also gives you valuable protections. A DME’s time, date, location, and nature must be reasonably convenient to you. The insurer also cannot force you to undergo an excessive or unnecessary exam. The insurance company must provide and pay for transportation to and from the appointment. Your legal team can ensure the request and exam meet legal requirements and intervene to protect your rights if necessary.
How a DME Can Affect Your Case
After your DME, the report becomes part of your claim file. Your insurer can use it to decide on your claim or as evidence in a subsequent lawsuit.
Many DME doctors have a regular relationship with insurance companies. They may dispute the necessity of your treatment, conclude your injuries pre-exist the accident, or opine that they are less severe than reported. Any of these “discrepancies” can potentially harm your ability to receive PIP benefits. Oftentimes the DME will communicate with your adjuster outside of the four corners of the report.
How To Protect Your Rights During a DME
DMEs must be reasonable in scope and cannot exceed what’s necessary to evaluate your condition. However, you also have other rights during a DME, and should follow these tips to protect them:
- Record the Evaluation – You can visually and audio record the examination so long as you inform everyone that you are doing so.
- Be careful what you say – DMEs are strictly medical exams. You should be honest and consistent about your symptoms. However, do not speculate, discuss liability, exaggerate symptoms or share details about how the accident occurred. This information is generally irrelevant, and an examiner could use anything you say to harm your claim.
- Keep following your treating physician’s advice – A DME doctor may recommend treatments to you during the appointment, but they are only there to evaluate. Keep following your treating doctor’s advice unless your lawyer recommends otherwise. Generally, DME’s are NOT subject to medical malpractice claims for providing bad advice or for misdiagnosis.
- Document the process – Take detailed notes about the exam’s date, time, length, discussions, and procedures.
What Happens After the DME?
After the DME, the examiner will report their findings to the insurer. From there, an insurer may choose to:
- Approve your claim or continue benefits
- Dispute whether your medical treatment is necessary on a pending claim
- Deny benefits
- Reduce or terminate benefits you’re currently receiving
If the insurance company issued a denial or altered your benefits, your legal team can challenge the report using any of the following strategies:
- Submitting rationale from your treating physician
- Questioning the examiner’s qualifications
- Questioning the reasonable nature of the DME according to Michigan law
- Seeking testimony from third-party medical experts that disputes the DME
Contact a Metro Detroit Car Accident Lawyer
The Rochester and Sanford attorneys of Atnip & Associates, PLLC, can answer your questions and help you prepare for an upcoming DME. Since 2013, our team members have put their 85 years of combined experience to work fighting for injured clients throughout Michigan. This includes collaborating with dedicated medical experts who can accurately value your case and challenge an examiner’s findings if necessary. Contact our office today for a no-cost case review.
