IME Denials Attorney

What should you do, as a healthcare provider, if an Independent Medical Examiner determines that a patient’s injuries are resolved, and the insurance carrier issues a denial?

If an IME doctor determines that a patient’s injuries have resolved, the carrier will issue a global denial cutting off further treatment. Once this denial has been issued, the carrier will deny further bills that are submitted, but this does not mean that the provider should stop treating a patient. If a provider feels that a patient’s injuries have not yet resolved and that further treatment is medically necessary, they should continue to treat the patient and pursue reimbursement from the carrier in court or arbitration.

Doctor In Room

Should you keep treating the patient after an IME denial?

We advise our clients of the following: “You determine the medical necessity of treatment, not the insurance doctors or carriers. Just document your findings well throughout treatment.”

When a provider elects to continue to treat a patient post-IME cutoff, it is crucial that there are contemporaneous exams or records that serve to rebut the IME doctor’s report(s). Our practical advice is to do a reevaluation the week before the IME and the week after if possible to document the extent of the patient’s injuries and to rebut the IME doctor’s report findings of resolution or normal where the IME doctor is acting more as an advocate for the carrier than the designated “Independent Medical Examiner”.

When should exams and treatment be performed?

Exams that are performed within a month before or after an IME are extremely valuable because they are used by your lawyer to contradict the findings of an IME doctor and persuade an arbitrator or judge that the treatment was medically necessary.

Thorough, contemporaneous exams that include a quantified range of motion restrictions, provocative orthopedic tests, and neurologic testing, will often rebut the findings of an IME exam and establish that treatment was necessary.

Thus, if a provider continues to treat a patient post-IME, re-exams should be performed frequently, and AT MINIMUM on a monthly basis.

What are the best practices for submitting bills for treatment after an IME Denial?

After an IME denial of future treatment, bills for treatment should still be submitted to the carrier, as the denials that the no-fault carrier generates will aid in establishing a case at arbitration. A provider may continue to treat a patient as long as they feel the treatment is necessary. Arbitrators will award reimbursement when the medical record clearly indicates that further treatment was warranted, i.e. medically necessary.

Do you have more questions about New York State No-Fault Insurance Collections?  Healthcare providers can download a complimentary e-book here.  

Contact us for more information and a free evaluation of your case.

Contact Us

What Our Clients Are Saying

TonaLaw
5.0
Based on 297 reviews
powered by Google
Amber PalermoAmber Palermo
17:50 23 Dec 22
The professionalism and expertise of the TonaLaw team is unmatched. I’ve worked with Juliet and she was incredibly knowledgeable, friendly and I could tell that she cared about helping me. If you’re looking for a legal team that helps with you any problem, big or small, TonaLaw is a team you can trust.
Regan moriartyRegan moriarty
16:49 23 Dec 22
The TonaLaw team is full of wonderful and hardworking people. I have personally worked with Juliet and she is excellent. You can tell she truly cares about the work she is doing. Highly recommend.
Elizabeth MartinezElizabeth Martinez
15:42 16 Dec 22
I can not be thankful enough for the amazing experience Tonalaw has given me from the very beginning. If you are looking for a lawyer who truly cares about your case then TonaLaw is for you. The amount of time and dedication they put in a case really shows how above and beyond they go. Not to mention how sweet everyone is really makes it a pleasure to work with TonaLaw.
Beatrice CestaroBeatrice Cestaro
22:06 14 Dec 22
I am extremely satisfied and happy to have chosen Tonal Law . The whole experience was flawless And I had absolutely no issues throughout the entire process. Everyone was so helpful and on time with everything, answered any questions I had, and we’re always easily available if I had any concerns. I basically did not have to lift a finger or do absolutely anything at all but answer a few questions. I put my full trust into Tona Law and I’m happy I did so. Would for sure recommend to any of my family and friends.
Anita AbramsAnita Abrams
21:14 05 Dec 22
Tona Law was an absolute pleasure to work with. As a local ART and Custom Framing resource, we helped to enhance their new offices, with beautiful and sophisticated, well curated artwork. Tom and his team were closely involved in all of the selections, and the environment is warm and friendly, as a result. Everyone at Tona Law, is considerate and professional.
Dawn DemartinoDawn Demartino
16:25 11 May 22
From start to finish I was informed every step of the way of the status and updates of my case… the time and steps taken to resolve my case in the best possible outcome was just one of the many great things Tonalaw provided. Personal care and commitment is top notch. Thank you !!
Louis B.Louis B.
15:27 08 Apr 22
Over the last few years Tona Law has guided me through the process with clear communication throughout. They are truly a client advocate and will do everything in the best interest of the client. Cannot thank them enough for all their work done for me.
Richard WoolleyRichard Woolley
19:49 26 Mar 22
Tom Tona and his team are fantastic. They do a great job for their clients. Can't recommend them highly enough.
Stacy LofredoStacy Lofredo
23:41 24 Mar 22
Tona Law has simplified no fault medical billing in a way that allows staff to effortlessly navigate through what could be a confusing process. Their staff is knowledgeable and responsive that we never have to worry about the ever-changing regulations because they are on top of keeping up to date with any changes in keeping their clients informed which is priceless!
Ruben ReyesRuben Reyes
15:29 13 Aug 21
They responded right away and were very professional. Brittany Reyes was very helpful. Thank you for your help
Randy RodriguezRandy Rodriguez
03:24 09 Aug 21
Would highly recommend if anyone is seeking any legal advice!
js_loader