IME Denials Lawyer in NY

Lawyer signing a papers

New York implemented a “No-Fault” insurance system to ensure that patients receive immediate care. For patients to receive timely care, providers need to be confident that they’ll be paid on the care they render patients. Over the last several decades it has become increasingly difficult for healthcare providers to get reimbursement. This is because the increase in the total number of providers participating in the No-Fault system and increase in the volume of expensive procedures has led to insurance carrier’s deploying increasingly aggressive counter-measures to control costs. 

A common insurance carrier tactic is to deny reimbursement based on the results of the patients’ Independent Medical Exam (IME). An IME is performed by a doctor hired by the insurer and so they collect a fee from the insurer for the work they do. Because the insurer pays the IME doctor the doctor is therefore incentivized to produce an insurer-friendly IME report — because they know if they do not, the insurer may simply choose to hire a different doctor for the next IME.  

Better Understand the IME Process

An IME is an examination ordered by an insurance company for the doctor to determine whether the accident victim’s injuries have resolved or whether they persist and the injured is therefore eligible for additional treatment under the No-Fault insurance policy. 

Insurance companies often use IMEs in an attempt to avoid paying out on claims. We believe they do this because they select IME doctors who are skeptical of victims’ claims or overwhelmingly supportive of the insurer’s position. These doctors are less likely to find that the victim has suffered serious injuries than a truly independent party would be.

A few different justifications for an IME denial include:

  • The insurance company might claim that the victim has already recovered from their injuries and does not need any further treatment.
  • The insurance company may say that the victim’s injuries were not caused by the car accident but by something else.
  • The insurance company may say that the victim’s injuries are not as severe as they claim, and therefore they do not need the treatment being sought.

These types of denials may be devastating for the injured person, who may be denied additional care by their provider, and of course it’s challenging for the provider as well because they risk providing additional care without being reimbursed. 

Fight an IME Denial Work With a Lawyer

If the IME finds that the patient’s injuries have been resolved, the insurer will deny reimbursement for additional care. If you believe that the injured person’s injuries are unresolved and continue to provide care your future claims are likely to be denied. 

To recover on these denied claims in NYC area, we recommend that you find an New York No-Fault Attorney who will go through the report and identify omissions or oversights, such as improperly cited medical journals that are used for justification, proof of an inadequate exam, exam details that are contradicted by medical records from other providers, or other reasons.

Your lawyer will then use this information to fight the denial and get the insurance company to pay for the injured person’s medical care. If you have been denied coverage after an IME, contact The Sigalov Firm today to schedule a free consultation with an experienced IME denial lawyer in New York.

Get a Free Consultation About Your IME Denial

Failing to treat a patient you believe should be treated is an unacceptable situation and one that our experienced legal team at The Sigalov Firm is ready to help you fight. We have a proven track record of success in IME denial cases, and we can put our experience and resources to work for you. Contact us today for a free consultation to learn about how an IME denial lawyer in New York can help you fight for the compensation you deserve so that you can continue providing care for your patients. We will review your case and help you understand your legal Schedule your appointment today for a free consultation, so that you can continue to provide care to your patients without the insurance company holding up or denying you compensation.