Independent medical examinations (IMEs) are often less “independent” than the term suggests. Disability insurers work closely with a network of doctors and medical providers whose primary goal is to build a case against claimants so that the insurer doesn’t have to pay out. If an insurance adjuster schedules you for an IME, it’s important that you are prepared.
However, undergoing an IME doesn’t mean you have to lose your benefits. Bryant Legal Group outlines the IME process, discusses some IME doctor tricks, and explains how you can protect your long-term disability claim from a damaging IME report.
What Is an Independent Medical Examination?
Most long-term disability plans will require you to undergo occasional independent medical examinations. IMEs are medical exams conducted by a provider hired by the insurance company to assess a claimant’s eligibility for disability payments.
Insurance adjusters may also request IMEs of their existing policy holders for other reasons:
- They want an updated psychological evaluation or physical examination to make sure you still qualify for benefits.
- There’s evidence that suggests your condition has changed or improved, which may affect your benefits.
- Your insurer has noted “red flags” or inconsistencies in your claim.
- Your insurer is looking for a reason to deny your claim.
While IME doctors are meant to be completely neutral, this is rarely the case. Most IME doctors make their living performing IMEs for insurance companies like Unum, who provide generous compensation for one-time examinations. IME doctors understand that if they consistently side with the disabled claimant, they’ll lose the insurance company’s business.
Because IME physicians are incentivized to find a reason to deny a claimant’s benefits, it’s important that you go into the exam prepared.
Do I Have to Attend My Insurer’s Independent Medical Examination?
Attendance of requested IME appointments is typically a condition of your disability insurance policy. This means that opting out of an IME may cost you your disability benefits.
If you have a serious conflict, call your long-term disability lawyer. They may be able to reschedule your examination. However, refusal to attend the IME could mean giving the insurance company an excuse based on the policy terms to cut-off your right to long-term disability benefits.
What to Expect During an IME Appointment
Independent medical examination doctors vary in their approach. While some physicians perform very detailed, lengthy exams, most IMEs are relatively short.
An IME will generally be like any other routine doctor appointment. You’ll most likely be asked to sign a few forms upon check-in. Always read documents carefully before signing them. You can decline to sign anything you aren’t comfortable with or do not understand. Consult your lawyer if you’re unsure about any of the IME documentation.
After a routine exam, the doctor may order additional testing like x-rays or blood work.
The IME doctor will send a written report to your insurance company that outlines their assessment of your degree of disability. It’s not uncommon for an IME report to favor the insurance company and suggest that you’re malingering.
What’s Malingering and Why Does It Matter?
Malingering is a legal term used by disability insurance companies to describe a claimant who exaggerates the severity of their condition in order to continue receiving benefits.
If your insurer’s doctor suggests you’re malingering, don’t panic. It’s only one doctor’s opinion, and it’s most likely a biased one. Your disability insurance lawyer is here to help you build a case that proves otherwise.
RELATED: What Is a Bad Faith Insurance Claim?
5 Tips for Passing Your IME Appointment
Even if your insurance company denies your case based on an IME report, you can fight back. However, there are a few ways you can strengthen your claim from the beginning.
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Be Honest About Your Symptoms
IME doctors typically keep a sharp eye out for any sign of malingering. If you exaggerate your symptoms during the exam, they will notice and report it. Don’t exaggerate, but don’t minimize your symptoms, either. If you’re experiencing pain or other symptoms, be just as transparent as you would be with your treating physician.
Only answer the questions you’re asked. Keep your answers as simple as possible, without going into details that the doctor hasn’t asked for.
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Build Strong RelationshipswithYour Treating Doctors
Medical records are essential to every long-term disability claim. Your records can help establish the severity of your condition, your abilities, and the steps you’ve taken to get better.
When you see your own general physician and specialists consistently and give complete and accurate information about your medical issues, the resulting records should counteract a report from a one-time examination.
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AssumeYou’reUnder Surveillance Before and After an IME
Disability Insurance companies frequently hire private investigators to track the claimant before and after their independent medical examination and monitor their social media. When they order this surveillance, they are seeking to find out whether the claimant’s day-to-day routine will be inconsistent with their conduct and behavior at the IME doctor’s office.
When you go to your IME appointment, the doctor’s staff will probably watch you enter and exit the building. It’s not uncommon to see IME reports where the doctor implies that a claimant’s gait and pain behaviors changed as soon as they entered or exited his building.
While you can’t stop a dishonest IME doctor from making false or unfair statements, it’s important that you act honestly and consistently before, during, and after your IME.
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Bring a Trustworthy WitnesswithYou
We often suggest that our clients bring a trusted family member or loved one with them, if possible. That way, if the doctor makes false claims in their report, you’ll have another corroborating witness.
Ask your witness to sit quietly in the examination room and take notes. Discuss with them ahead of time what details to make particular note of, such as:
- The start time and end time of the exam
- Any statements or comments the IME physician makes about your condition or abilities
- What activities or procedures the exam consists of
- Any difficulty, discomfort, or other symptoms you report
- Anything else that occurs during the appointment that seems important or unusual
The person you bring doesn’t need to interact or participate in the examination at all. You also may be able to record video or audio of the exam, but you should ask your lawyer beforehand.
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Consult an Experienced Disability Insurance Lawyer
When an insurer schedules an independent medical examination, they’re often ready to fight, especially if it means they won’t have to pay out. So, it’s a good idea to start preparing your case for an appeal.
When you consult with a long-term disability lawyer before an IME, they can help you fully prepare for the examination. They may even be familiar with the physician you’re seeing and can give knowledgeable advice about the IME doctor’s tricks and tactics.
RELATED: How Long Can You Be on Long-Term Disability? It Depends
What To Do After Your IME Appointment
You can remain proactive about protecting your disability benefits after your IME appointment. As soon as you’re through with the exam, you can begin taking the following steps:
- Document the exam. Even if you brought a witness, it’s still a best practice to write down everything you recall from the exam while it’s still fresh in your mind. Your notes and your witness’ notes can supplement each other to provide more thorough information for your disability attorney.
- Continue with your regular medical appointments and treatment plan.
- Request a copy of your IME report, if possible. If you aren’t automatically given a copy after your IME appointment, you may try to request one from either the insurance company or the examining physician’s office. However, please note that this option may not be available in non-ERISA cases. In ERISA cases, you are only owed a copy of your IME report if an adverse benefit determination is made.
- Review your IME report carefully, if you receive it. Read it and compare it with your notes or recordings of the appointment. Flag any discrepancies or misinformation in the report.
- Contact your attorney. Be sure to give them all of your own documentation. If you find any issues in the report, share them with your attorney.
Bryant Legal Group: Fighting for the Long-term Disability Rights of Illinois Residents
At Bryant Legal Group, we help people across Illinois with their long-term disability claims. To schedule your free initial consultation with an experienced disability attorney from our team, call us at 312-629-9316 or use our online contact form.
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.