The Adverse Medical Examination
The Types of AMEs
Insurance companies and defense lawyers on the other side of a personal injury case
almost always demand that the plaintiff be examined by a doctor of their choice. They like to call that process an “independent medical examination (IME).” Unfortunately, in reality, this actually is more of an “adverse medical examination (AME).”
Most of the time, the examining physician hired by the insurance company or defense lawyer disagrees with the plaintiff’s treating doctors and issues a report or testifies against the plaintiff.
The No-Fault AME
Personal injury cases involving motor vehicle accidents in the state of Minnesota, no-fault insurance coverage is always an issue. Whenever a person has been involved in an automobile accident and has no-fault insurance coverage under Minnesota law that person has a right to make a claim for no-fault benefits (medical expenses, mileage, prescription drugs, wage loss and replacement services) against his or her car insurance company. As part of that process, Minnesota law gives the no-fault insurance company the right to request an AME by a doctor of their choice. If the injured person fails to attend the AME, the insurance company will refuse to pay any further no-fault benefits.
The Liability AME
Almost every personal injury case arising in Minnesota, Wisconsin and other states involves AMEs. This includes automobile accidents, medical malpractice, premises liability accidents, products liability and construction accidents.
In personal injury cases where the injured person is making a claim for physical or emotional damages against a person or entity responsible for the injury (for example, the driver of the other vehicle, the manufacturer of a defective product, a doctor who commits malpractice, etc.) that injured person places his/her physical and emotional condition into controversy. As such, law allows the defendant’s insurance company or defense lawyer to review medical records and other documents that refer to the injured person’s physical and emotional health both before and after the date of the accident. In addition, the insurance company and defense lawyer generally have a right to request an AME by a doctor of their choice.
The Nature of an AME
AMEs are conducted the same way whether they are for no-fault cases or liability cases. The party requesting the AME selects the physician. There are a number of physicians who do AMEs on a regular basis. The physician is usually a board certified neurologist, orthopedist or other specialist. They usually charge a significant amount for the AME. After scheduling the AME, the party requesting the AME will usually send all of the medical records to the doctor for review. The doctor will review those medical records either before or after the AME.
The AME itself is usually quite short. The AME doctor or an assistant will take some background information on the nature of the accident, prior medical history, treatment after the accident, current symptoms, etc. The doctor will then perform a physical examination, which may be very short, sometimes a few minutes in length.
Your Conduct with the AME Doctor
It is extremely important to attend your AME examination. If you miss the examination, the doctor will charge a substantial cancellation fee, and the insurance company or the defense lawyer will claim that you should pay that cancellation fee. Try and be at the AME at least 15-20 minutes early.
Generally, you do not have to take anything with you when you go to the AME unless you are asked to do so beforehand. Occasionally it may be necessary for the injured person to take x-rays or other documents to the AME.
One of the most important things to remember about an AME is to treat the AME doctor cordially and with respect. Although in most cases the AME doctor will issue an unfavorable report, that report is even worse if it suggests that you were uncooperative, evasive or unpleasant. Therefore, no matter how difficult, be nice.
As indicated above, during the course of the AME, the doctor will ask about any prior accidents, injuries, medical conditions, etc. It is important for you to be prepared to answer those questions. In most cases, the doctor either already knows or will find out about prior medical conditions and the failure to answer those questions in a truthful, direct manner will lead the AME doctor to assume that you are being either dishonest or evasive. The AME doctor will then put that in his or her report, which is also harmful to the case.