QuestionDear Claim Guy,
I received answers to my earlier questions dated Nov 26/27,12 and Dec 6, 12.
DOA: 03-03-12, Medical Treatment Continues with Drs. ( PCP, Neurologist, Physiatrist, Psychiatrist, Psychologist ) Medications, Testing ( MRI's, Lab tests ) Traction, Therapies & Exercises. Till this date total medical expenses $36K. (Includes 10K Med-Pay) I am 63 yr old and still in pain, it starts base of skull and radiates to back, sides and center of head. Focus and concentration triggers more pain. Brain MRI showed some white spots on Brain but Neurologist could not pin point cause for the.
I, Signed Agreement to Release Underinsured Driver (driver at fault) and filed claim under our UIM Coverage (100K/300K).
UIM Adjuster reviewed the case and wanted to review accident and medical treatment related questions in person and the recovery progress. My husband and I met with adjuster, detailed questions and answers were exchanged. She was Polite but stiff.
She asked one weird question to me when my husband went to men’s room: When did I have Menopause; was it difficult to go through it? I answered her but I could not take it off my mind, what is the relation between Menopause and auto accident.
Could you please advise me on the following:
She wants me to go through the Independent Medical Examination ( IME ) with one of their Physician Network Doctors.
i. What is their motive for IME
ii. Am I bound to agree for IME?
iii. If yes, who will be the ideal person to accompany me during IME
iv. Can we request to have it tape / record for our document.
v. IME assesses present medical situation but how it will connect with past pain, suffering that I have gone through in last 14 months since the date of accident (3/3/2012) & medical treatments in this period. We have already provided them with all medical reports for each visit to doctors so far (Neurologist, Physiatrist Psychologist) .
vi. Whose assessment prevails IME or my doctors who have treated me for the past 14months
vii. Our own out of pocket expenses have reached more than 14,000/- plus $7,000 which we are paying in instalments to avoid collection. Is it customary to ask them to reimburse us, before settlement and the chances of them reimbursing while claim goes on.
Thank you very much and with The Best Regards
sun
Answeri. What is their motive for IME.....THEY WANT ANOTHER OPINION TO MAKE SURE THE THE TREATMENT COURSE IS APPROPRIATE AND RELATED TO THE ACCIDENT. IT IS UNUSUAL FOR TRETAMENT TO CONTINUE FOR SO LONG.
ii. Am I bound to agree for IME? ...... YES, THEY HAVE THE RIGHT UNDER THE POLICY.
iii. If yes, who will be the ideal person to accompany me during IME.....I DOUBT YOU CAN BRING ANYONE ALONG. THEY WOULD LIKELY HAVE TO STAY IN THE WAITING ROOM.
iv. Can we request to have it tape / record for our document. ....I DOUBT THE DOCTOR WOULD AGREE TO THIS.
v. IME assesses present medical situation but how it will connect with past pain, suffering that I have gone through in last 14 months since the date of accident (3/3/2012) & medical treatments in this period. We have already provided them with all medical reports for each visit to doctors so far (Neurologist, Physiatrist Psychologist) .....THE IME DR WILL REVIEW ALL THE MEDICAL RECORDS AND USE THEM IN CONJUNCTION WITH HIS/HER EXAMINATION.
vi. Whose assessment prevails IME or my doctors who have treated me for the past 14months.....THE INSURER WILL REVIEW ALL THE EVIDENCE AND THEN MAKE A DECISION. IF YOU DISAGREE WITH THEIR DECISION, YOU HAVE THE OPTION OF SUING THEM.
vii. Our own out of pocket expenses have reached more than 14,000/- plus $7,000 which we are paying in instalments to avoid collection. Is it customary to ask them to reimburse us, before settlement and the chances of them reimbursing while claim goes on.......THEY NORMALLY WILL NOT ADVANCE UIM PAYMENTS BUT THEY COULD AGREE TO DO SO IN A SHOW OF GOOD WILL. IT MIGHT DEPEND ON WHETHER OR NOT THEY THINK YOU ARE BEING CONSERVATIVE IN YOUR TREATMENT PLAN.
