Why Hire an Attorney? Games the Insurance Companies Play...EUO's and IME's
Posted on Oct 4, 2010 12:51pm PDT
WHY HIRE A PERSONAL INJURY ATTORNEY?
Unfortunately, the issue may not be whether you have actually done something "wrong", but rather, whether your insurer suspects you may have done something wrong. There are numerous "red flags" (so called by insurers) which may alert an insurer of a potentially fraudulent claim. If your insurer "finds" one or more of those red flags, you may be in for quite an ordeal, even though your claim is completely legitimate. Moreover, insurance companies are able to take advantage of a person who is not represented by an attorney simply put, because the injured person does not know his/her rights or duties after a loss.
Typically, all automobile policies contain provisions allowing an insurer to take the sworn testimony of one or all insureds. This is a contractual provision written in your insurance policy. Many courts have held that an insured's failure to attend an EUO results in a breach of contract. This means your insurance company will owe nothing for your claim. Reasons for the request for an EUO include but are not limited to: the insurer suspects fraud, either in the occurrence of the loss (staged accident), the claim (exaggerated) or the application (material misrepresentation in failing to list other residents on the application of insurance, concealment, etc.). The insurance company may, as a course of business, routinely request EUO's of all claimants even if it asserts it is doing so for a specific investigative reason, hoping the claimant will not appear, excusing it from paying on the claim. In substance, if the policy so requires, you must attend the examination and bring the documents which you are reasonably required to bring. An examination under oath can be a several hour ordeal where you are questioned, under oath (a court reporter typically records the proceeding) about a broad range of issues. The examination is often conducted by an attorney representing the insurance company. It is not wise to an examination under oath without competent, experienced legal counsel.
The insurance industry calls this type of appointment an Independent Medical Examination (IME); the Plaintiff's attorneys call this examination (among other things) a "Compulsory Physical Examination" (CPE) because we do not believe they are independent exams. Your PIP carrier, under the provisions of your PIP coverage, schedules the appointment. It is very important that you attend the appointment. Your own insurance company is required to pay a portion of your medical bills and lost wages as part of your Personal Injury Protection (PIP). Their policy (contract) allows them to have a doctor examine you to determine if further treatment is needed. If you fail to attend the IME/CPE you can forfeit your remaining PIP benefits.
The doctors are not independent or conducting peer reviews. Merriam-Webster Dictionary's only definition of "peer review" is: a process by which something proposed (as for research or publication) is evaluated by a group of experts in the appropriate field.) They are hired by the defense and paid by the defense. If the jury hears that doctors are "independent" or a "Peer Review," the jury may be confused into believing or thinking the doctors were appointed by the court, a governing body, or with the approval of the Plaintiff or the Plaintiff's attorney.
It is important that you consult with an attorney if you are injured in an accident and requested to appear before an IME doctor for an examination.