The Independent Medical Examination in Long Term Disability Cases

independent medical examination IME long term disabilityIndependent Medical Examinations and Long Term Disability

What is an IME?

Whenever you allege a physical or mental disability in a long term disability (LTD) claim, the insurance company has the right to investigate the condition as part of its claim determination process. Almost every LTD policy contains a clearly defined clause that allows the insurance company to send the claimant to an independent medical examination (IME) upon request or else risk denial of the claim and/or voiding the insurance policy.

First of all, we don’t like the use of the term “Independent” in this context.  There is nothing “independent” about this exam. If you believe that the insurance company has chosen the particular doctor performing your examination because they believe the doctor is “fair,” then you are being naive. The fix is in on the examination. The medical examination will be conducted by a doctor who is frequently used by the insurance company to conduct medical examinations.  The insurance carrier is not going to pay good money for bad results. Insurance companies use the same examiners time and again in each community to get what they need: medical opinions to use to deny your claim. In short, the results of these exams tend to be in favor of the insurance companies.  As such, we request that they be called “Defense Examinations” or “Compulsory Medical Examinations”; there is nothing “independent” about them.

In almost every case, our client tell a similar story of how the IME was conducted. The examination is usually a cursory affair- the physician conducts a minimal interview and takes a short history from the claimant, which is then followed by a quick “once over” check of the claimant’s medical condition, and then the IME is over. The doctor performing the examination does not want to find any problems; in fact, the defense physician wants to make sure not to find any evidence of your disabling condition. Always remember – the defense physician is not concerned about your well-being; the IME doctor is more concerned about the well-being of his or her bank account.

Just read the doctor’s final report. It is common for the defense examiners to go beyond the objective medical evaluation process and attack the credibility of your claim. You are likely to find phrases such as “complaints are excessive for condition demonstrated”, “symptom exaggeration”, “secondary gain”, or “malingering.” The purpose of using this language is clear. The doctor intends to make the claimant look dishonest, which is easier to do than undermining the actual findings of the treating doctors.

In addition to using a biased doctor against you, you should expect that the insurance company will hire an undercover surveillance private investigator to film you. Should should expect to be recorded anywhere from a few days before the day of your examination, the entire day of the examination, and up to a few days after the examination. The investigator will be waiting outside your home to keep watch on you and record your every move during these times. So, just keep in mind that all of your activity during these times will be taped and held against you. Highlights from these recordings will be provided to the evaluating doctor who will then make additional blanket statements, such as stating that your activities “were in excess of your stated abilities.”

Expect the IME examiner to watch you walk back to the parking lot after the examination (or claim that he or she did so) to try and find evidence of malingering.

The insurance company may provide you with a copy of the IME report upon request; however, you have no absolute right to receive a copy of the report until after your claim has been denied.

More About The Doctors Who Perform IMEs

Insurance companies may pay thousands of dollars for an IME report. Many of the doctors who perform IMEs for disability insurance companies make a substantial portion of their income from IMEs. They are familiar with disability insurance terminology and use their familiarity with the process you in an effort to please the insurer and keep the examination payments coming. We have found that these examiners will not hesitate to ignore their professional training and make sweeping statements to defeat your claim. They know what is expected of them and that is what they are paid to do.

We have found that there is a doctor in just about every community that will perform IMEs that favor insurance companies. However, especially in more rural areas, the insurer may not have a local doctor available to do their dirty work. In such circumstances the insurer may schedule the claimants to attend examinations hundreds of miles away. Or, the insurance company may even fly a doctor in to defeat your claim.

Do You Have to Attend the IME?

A common question we are asked is whether you must attend an “Independent Medical Exam”, or IME, upon request of the insurance company.

The answer is: “It depends on what your policy says.” Your duties and obligations will be set forth in the insurance policy.  If it says you must present for an exam upon request, then you must do so.  If it does not have such a provision, then you may not have a contractual obligation to go to the exam.

I can tell you that most policies do have such a provision, however.  Thus, you should carefully review your insurance policy to determine whether you must go to this doctor.  If you a clause in your contract that says you must “Cooperate” with the insurance company in its investigation into your claim, and you fail to “cooperate” by not going to a medical exam, then you may be denied benefits for your refusal present for the medical evaluation.

What Should You Do To Prepare?

You should make sure you are prepared for the IME, and you should consider documenting or recording the examination. An experienced attorney can help you  understand your contractual obligations and assist you in preparing for this medical examination.  If you would like to speak with an experienced long term disability attorney, please contact Mr. Nick Ortiz at 850-308-7833.