IME Red Flags: Low-Speed Collisions & Questionable Injuries

When a minor fender bender results in a major injury claim, it inevitably sparks some red flags. As an adjuster, low-speed collisions often present a challenge—how do you determine if an injury is legitimate or exaggerated? This is where Independent Medical Examinations (IMEs) become a crucial tool.

While some soft tissue injuries can occur in low-impact crashes, the mechanics of the accident should align with the reported medical conditions. When they don’t, it’s time to dig deeper. In this article, we’ll break down the key IME red flags that help adjusters identify questionable injury claims, ensure fair case evaluations, and prevent unnecessary payouts.

Crash Dynamics vs. Claimed Injuries

Understanding the relationship between crash dynamics and claimed injuries is crucial for claims adjusters. Vehicle speed, impact angles, and the extent of damage all play a significant role in determining whether an injury claim is legitimate. For example, low-speed collisions typically cause less damage, and the types of injuries reported should align with the forces involved. A high-speed crash may lead to more severe injuries, whereas a low-impact or no-impact accident raises red flags, especially when the injuries reported seem disproportionate. Evaluating the physical damage to the vehicle, along with the dynamics of the crash, helps adjusters assess if the injuries make sense in context.

Common injury patterns associated with crashes can provide a roadmap for adjusters to identify potential fraud or exaggerated claims. Soft tissue injuries like whiplash are common in rear-end collisions, but the severity should match the severity of the crash. Similarly, the location of the damage to the vehicle can provide insight into the direction of impact and whether it correlates with the claimed injuries. For instance, if the front of the vehicle is undamaged but the claimant reports significant neck or back injuries, it may be worth digging deeper into the claim’s validity. This understanding helps adjusters make informed decisions when reviewing claims, ensuring that payouts are fair and justified.

Frequently Asked Question: Is it okay to enclose photos of the no-impact damage automobile when you have questionable mechanisms for injury with an IME?

IME Director of Operations and crowd-favorite presenter Susannah Michael responds: “Absolutely! If you have photos showing the damage, that can help paint a picture of the accident for the physician and better understand the severity of the accident.”

Resources for Identifying Crash Dynamics

Consult the Experts: As an adjuster, you can collaborate with accident reconstruction specialists who are trained to analyze crash dynamics in detail. These experts can provide valuable insights into how vehicle speed, impact angles, and other factors contributed to the accident and the resulting injuries.

Event Data Recorder: Many vehicles nowadays are equipped with black box technology (Event Data Recorders), which records information such as speed, braking patterns, and impact force during a crash.

Collaborate with Medical Experts: Medical experts, especially those with experience in accident-related injuries, can help adjusters understand whether the injuries are consistent with the reported crash details.

IME Red Flags: Low-Speed Collisions

If a claimant reports symptoms, like extreme pain, that don’t align with the nature of the crash or the damage to the vehicle, it could be a sign of potentially inflating symptoms. By spotting these red flags early, adjusters can avoid overpaying for claims that don’t align with the evidence or the severity of the accident. When dealing with low-speed collisions, you should be on the lookout for these red flags in the IME process.

Key Red Flags to Watch For:

Inconsistent Medical Reports: If injuries noted by the IME physician don’t match the accident details (e.g., a severe spinal injury from a minor bumper tap), it’s a sign the claim may be exaggerated or unrelated. Make sure to compare early medical records with later diagnoses, if you spot major discrepancies raise concern to your SIU team.

Delayed Treatment: If a claimant waits weeks or months before seeking medical care, it raises questions. Genuine injuries typically need immediate medical attention, if a claimant delays medical care it can mean that the condition is unrelated to the crash.

Exaggerated Pain: A claimant reporting extreme, debilitating pain from a low-impact collision, especially paired with minimal vehicle, is another red flag. IME professionals should assess whether reported symptoms align with the expected injury patterns for the accident. An experienced physician who has dealt with crash injuries will quickly identify inconsistencies.

Subjective Symptoms: Claims of chronic headaches, dizziness, or widespread pain without corresponding medical evidence (inconclusive imaging or diagnostic tests) should prompt closer scrutiny.

Prior Claims or Pre-Existing Conditions: This one might seem like an obvious red flag, but it’s always a good reminder that if the claimant has a pattern of prior injury claims or pre-existing conditions that match the reported injuries, it’s a good idea to investigate further on whether the accident was responsible for the injuries.

There is no one thing you can do to ensure that fraud isn’t being committed but in most cases, an IME is a great option if you have any of the concerns listed above.

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