Ethics and the IME

A Video Explaining The Ethical Obligations of the Claims Person when Retaining an IMEShow more

Medical examiners have established their own codes of ethics with regard to an IME and are obligated by those codes to report their findings fairly and accurately. The American Board of Independent Medical Examiners has published a code of Ethics.

The adjuster who follows the rules profiled by the American Board of Independent Medical Examiners, which are similar to those posited by the International Association of Special Investigation Units (IASIU), should receive appropriate independent medical advice.

Insurance is a business of the utmost good faith. The IME is a tool that the ethical adjuster must never abuse. Although insurers are frequent victims of fraud, they must treat everyone they come in contact with as honest until proven by a preponderance of the available evidence to be a fraud. The purpose of the IME is to verify the extent of injury, not to establish fraud. If the extent of injury found by the IME is different from that presented in the claim, the SIU or independent counsel should be contacted to evaluate the results of the IME and determine if a fraud investigation is required.

When an independent medical examiner’s report is required the adjuster should act so as to ensure that the report is scrupulously independent, or risk becoming a defendant paying extreme punitive damages for a conspiracy to defraud an insured.

© 2021 – Barry Zalma

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 52 years in the insurance business. He is available at http://www.zalma.com and zalma@zalma.com.

Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.

Over the last 53 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.

Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma;  Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ Read posts from Barry Zalma at https://parler.com/profile/Zalma/posts; and the last two issues of ZIFL at https://zalma.com/zalmas-insurance-fraud-letter-2/  podcast now available at https://podcasts.apple.com/us/podcast/zalma-on-insurance/id1509583809?uo=4