Michigan PIP Denied After an IME? Your Options and Deadlines

The exam lasted eleven minutes. The doctor didn’t touch your back. Two weeks later, the letter said you were “fully recovered,” while you’re still sleeping on the couch because stairs hurt.

If that sounds familiar, you’re not imagining it. You’re not exaggerating. And you’re not alone.

What you walked into may not have been much of a medical exam. Let’s talk about what happened, why your Michigan PIP benefits were cut off, and what you can do about it before the clock runs out.

What should Michigan PIP be paying for?

PIP should be paying reasonable and necessary crash-related care, part of your lost wages, and household help, up to your policy’s limits (MCL 500.3107). A denial letter usually leans on one exam and skips the rest of your record.

When you pay your premium, your Personal Injury Protection benefits are supposed to cover:

• Medical expenses: reasonable and necessary care related to the crash, for life under older unlimited policies, or up to the limit you chose under post-2019 reform policies (what happens when that limit runs out).
• Wage loss: 85% of lost gross income for up to three years after the crash, subject to a monthly maximum set by the state.
• Replacement services: up to $20 per day for things you can’t do anymore (laundry, yard work, childcare, grocery runs).
• Attendant care: if someone has to help you bathe, dress, or manage medications.
• Mileage: to and from medical appointments.

Notice what the denial letter doesn’t mention. It talks about the one doctor who said you’re fine. It doesn’t mention the physical therapist who’s been treating you for four months, your primary care doctor, the MRI, or the ER record from the night of the crash.

That’s worth noticing, and worth pushing back on.

Who does the IME doctor actually work for?

The insurer picks and pays the doctor. The “I” in IME stands for “independent,” but in Michigan no-fault the exam is requested and paid for by your insurer under MCL 500.3151.

That doesn’t mean every IME doctor is dishonest. It does mean the insurer chooses who examines you, pays for the report, and decides whether to use that doctor again. Some physicians do a large volume of this work for insurers. You, the person on the table, are not the client. You’re the subject of the report.

A genuinely independent exam would be one where both sides picked the doctor together, or a neutral party assigned one. That’s not what happened to you.

The rules the examiner has to meet

The 2019 reform tightened who can do these exams. Under MCL 500.3151, if your treating doctor is a specialist, the examiner must practice in the same specialty; if your doctor is board certified, the examiner must be too. The examiner must also spend most of their professional time in active clinical practice or teaching. If the doctor who examined you doesn’t meet those requirements, that’s worth raising.

What phrases in an IME report signal a weak denial?

Watch for four stock phrases that often stand in for real analysis. Pull out your IME report and look for them.

1. “Symptom magnification.” Translation: we’re saying you’re exaggerating, without proving it. It’s a clinical-sounding way to question your honesty.

2. “Subjective complaints unsupported by objective findings.” Translation: we’re discounting your pain because it didn’t show up on the tests we ran. Pain is, by nature, something you report.

3. “Pre-existing degenerative changes.” Translation: you have a spine, and adult spines show wear. This skips over aggravation of a pre-existing condition, which Michigan law can treat as a covered injury when the crash made it worse.

4. “At maximum medical improvement” or “fully recovered.” Translation: we’re cutting you off now, regardless of what your treating doctors say.

When several of these show up in a short report that ignores your treatment records, your treating doctor’s response can carry a lot of weight.

What does “delay, deny, defend” mean?

It’s the shorthand for a claims strategy of slowing payment, cutting benefits, and making challenges expensive. The phrase was popularized by Rutgers law professor Jay Feinman’s book Delay, Deny, Defend, a critique of insurer claim practices.

Delay. Drag out payment. Request more records. Schedule the IME weeks out. Every week without a paycheck or a therapy appointment makes a low offer look better.

Deny. Use the IME to cut off benefits. The denial doesn’t have to be right. It just has to be issued. Now you have to push back.

Defend. If you sue, fight every step. Make it slow and exhausting. Bet that you’ll settle for less rather than keep going.

Michigan law builds in pressure against this: overdue benefits earn interest and unreasonable denials can cost the insurer attorney fees. More on that below.

What are your options, and how long do you have?

You can get a rebuttal from your doctors, complain to the state insurance regulator (DIFS), and sue your insurer, but watch the one-year rule. Under MCL 500.3145, a PIP lawsuit can generally recover only losses incurred within one year before the suit is filed.

There’s one protection. Since the 2019 reform, that one-year period is paused (tolled) from the date you make a specific claim for payment until the insurer formally denies it, as long as you pursue the claim with reasonable diligence. Once the formal denial arrives, the pause ends and the clock runs again. So the denial letter matters: don’t sit on it for eleven months.

Your realistic options:

Ask for reconsideration. Some insurers have an internal review. It rarely reverses a denial, but it creates a paper trail.

Get a rebuttal report. Your treating doctor, or a new specialist, can write a report responding to the IME. Treating doctors who have seen you for months are often more persuasive than an examiner who saw you once.

File a complaint with DIFS. Michigan’s Department of Insurance and Financial Services takes complaints about auto insurers. It won’t resolve your claim by itself, and it doesn’t replace a lawsuit or stop the clock.

Sue for no-fault benefits. This is the option that forces the insurer to answer in court. Most Michigan PIP lawyers work on contingency, so you don’t pay up front. Pick one who knows the 2019 reform; here’s why an out-of-state lawyer can be a risk on a Michigan PIP claim.

Claim interest and attorney fees. PIP benefits are overdue if not paid within 30 days of reasonable proof of loss, and overdue amounts carry 12% simple interest per year (MCL 500.3142). If the insurer unreasonably refused or delayed payment, the court can order it to pay your attorney fees (MCL 500.3148).

Whatever you do, don’t sign anything asking you to release claims, and don’t give another recorded statement before talking to a lawyer.

If the denial is also costing you providers, read why your doctor may have dropped you after a car accident. And keep treating if you can: gaps in treatment are the next thing the insurer will point to. If wage loss was cut off too, see how Michigan wage loss works over three years.

You already know something is wrong

You were there for the eleven minutes. You know what happened and what didn’t. You know how you’re sleeping. You know which stairs you can’t take.

The letter in your hand is a business decision dressed up in a lab coat. One paid exam isn’t the whole medical record. Your treating doctors’ records count too.

Michigan no-fault law gives you real tools here. But laws don’t enforce themselves, and deadlines don’t wait. Get a free second opinion on your PIP denial while the one-year window is still open.

This article is general information about Michigan law, not legal advice for your situation.