Ethical Obligations of the Independent Medical Examiner

A Video Explaining the Use of an IME

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 the following Code of Ethics:

Physicians shall:

Be honest in all communications.
Respect the rights of the examinees and other participants, and treat these individuals with dignity and respect.

An independent medical examiner has a contractual relationship with the entity that employs them but no preexisting relationship with the subject of the examination. And this contractual relationship is often independent of, if not adverse to, the subject's relationship with the examiner's employer. To impose a categorical duty of care running from the independent medical examiner to the subject would put the examiner in an untenable position, if not create an outright conflict of interest. [Kirk v. Anderson (Utah Supreme Court, 2021)]

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.

The adjuster (and the SIU fraud investigator) must be dedicated to:

Promoting a coordinated effort within the industry to combat insurance fraud; providing education and training for insurance investigators; developing greater awareness of the insurance fraud problem; encouraging high professional standards of conduct among insurance investigators; and supporting legislation that acts as a deterrent to the crime of insurance fraud.

When an IME is retained the insurer should advise the IME of his obligations in writing, in the following manner:

You have been retained by the ABC Insurance Company to conduct an independent medical examination of the claimant and report to me, concerning the injuries sustained, the present condition, your prognosis and your evaluation of any continuing treatment needed by the claimant. To assist you in that regard we enclose as complete as possible all of the medical records of the claimant of which we are aware.

The purpose of your examination is to thoroughly review all relevant facts within your field of expertise so we may determine whether the injuries reported by the claimant captioned above was caused by the accident and, if so, the extent of the injuries so that we may properly evaluate his claim against our insured. We expect your examination to provide the Company with sufficient facts to assist it in its obligation to make a decision with regard to the claim.

© 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 54 years in the insurance business.

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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 training available at https://claimschool.com; articles at https://zalma.substack.com,  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 https://www.rumble.com/zalma ; 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/  The last two issues of ZIFL are available 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