A disability “Independent Medical Evaluation” describes the physical examination that a disability claimant is asked to undergo before an insurance company will either approve a claim or continue to pay benefits. The requirements for an IME are based on the provisions in the disability contract, and there may be some instances where the claimant does not have to comply with the request for an IME, but most contracts and most jurisdictions require an IME. There are many problems associated with IMEs resulting in numerous lawsuits brought by individuals concerning these examinations, including one heard by the United States Supreme Court. The most important issue: they are anything but independent.
The physician conducting the examination is paid by the insurance company. Physicians who report that claimants are not able to return to work based on their examination are unlikely to be retained repeatedly by the insurance company. Physicians who report that claimants are capable of going to work give the insurance company the information needed to deny or terminate a claim, and in return are retained to perform more IMEs. There are entire medical practices that do nothing but IMEs for insurance companies. It’s an extremely lucrative business for the doctors.
For claimants, the IME is a minefield that must be navigated carefully to avoid falling into traps.
Unless retained counsel advises you otherwise, you must attend the IME. There are numerous requirements, such as the proximity of the examining doctor’s office and their qualifications.
Do not go alone to the IME. Bring a trusted friend or a family member, and insist that they accompany you into the examination room. You may have to be assertive about this, but you should never go into an IME exam room without a witness.
In today’s digital world, you may want to use your cell phone to record the IME, although the physician may not like this. An experienced disability insurance attorney will be able to advise you based on the insurance policy and the laws governing your state.
Remember that the physician conducting the exam is being paid by the insurance company, and no matter how friendly or kind, he or she is not on your side.
Individuals who try to be good sports and make light of their condition are not helping their disability claim. If something hurts, say so. If you are asked to do something that you cannot, refuse and do not comply.
If the physician insults you by saying that you are unwilling to move in a particular way or calls you a malingerer, request that this be documented. A hostile examining physician cannot be considered be independent, and the entire IME may be considered flawed.
Bear in mind that the IME is an opportunity for the insurance company to gather evidence about you and your medical condition for use against you in an appeal or in a court of law. It may be your responsibility to undergo an IME, but it is the insurance company’s responsibility to pay benefits when you are unable to perform the specific tasks of your occupation.
One important point: the physician has already been provided with the insurance company’s file on your medical records and knows before you even step into their waiting room the insurance company’s desired outcome. The physician may also have information regarding the amount of your monthly benefit, something that is completely unnecessary and should be unethical for them to know. The IME is one in a long series of events that the insurance company will undertake as it seeks to find ways to avoid paying claims.
Your goal must be to protect yourself at all times throughout this process, with an experienced disability insurance lawyer and a primary care physician whose priority is you, so that you can focus on healing or learning to live with your disability.
Jason Newfield is a founding partner of the disability insurance law firm Frankel & Newfield. He has spent the majority of his legal career advocating for the rights of disabled workers. He has lectured other professionals, worked on a Federal Advisory committee, and published many articles in the field of disability insurance claims and litigation.
Secrets the Disability Insurance Companies Don't Want You to Know!