What happens if my disability carrier requests that I participate in an
IME or FCE?
The first thing is to cooperate. You have a duty under your policy to
cooperate with the investigation of your disability claim. Next, you should
determine where the exam will take place. If you are unable to provide
your own transportation, you should request that the company provide transportation
for you. Additionally, you should bring the examining doctor or FCE examiner
copies of your pertinent medical records, in case the plan or insurer
has not provided them. You should be aware that insurance companies commonly
hire private investigators to surveille claimants on the day of their
IMEs and FCEs and commonly for one or two days before and after the IME
or FCE. Lastly, it is wise to retain an ERISA attorney prior to your IME
or FCE. Such an attorney can help you investigate the professionals hired
to examine you.
Can I bring a friend, a video recorder and/or an audio recorder to an IME?
This depends on the laws of your State. Some states permit a person to
be present with you; others permit recording of the examination. Before
you appear at the examination with a friend or a video or audio recorder,
you should consult an attorney. You do not want to be perceived as refusing
to cooperate with the examining professional if he or she refuses to allow
either a witness or a recorder.
If my doctor says I’m disabled, do I have to submit to an exam by
the insurance company’s doctor?
Yes. The plan or your disability insurance company has the right to make
an independent evaluation of your claim and the opinions of your doctors.
For instance, in some circumstances, the insurance company may repeatedly
request examinations. Or it may ask you to attend an examination at a
great distance from your home. Even in these circumstances, the best choice
is to cooperate. Before you elect not to cooperate, please consult an
How will the results of an IME or FCE affect my case?
It depends. Sometimes, the results of a legitimate IME or FCE can confirm
your disability and encourage the plan or insurer to grant you benefits.
On the other hand, IMEs can be used as unscrupulous tools of the insurance
company to contradict your treating physicians’ conclusions and
cause your claim to be denied. That’s why it’s so important
to participate in requested IMEs and FCEs – since you can never
be certain of the outcome.
Do I have to be cooperative with my disability insurance company?
Your disability insurance company will, during the course of your claim,
ask you to sign releases, complete forms, answer questions by telephone,
maybe meet with field representatives, and even participate in independent
medical and functional capacity examinations. You should always cooperate
with these requests. Failure to cooperate can be an independent basis
for denial of your claim.
Do I have to sign a medical authorization form that allows my insurance
company to receive all my past and future medical records?
Yes. If you have further questions on this matter, you are always welcome
to call our offices to discuss your concerns.
Can I receive copies of the IME or FCE reports?
Generally, IME and FCE reports are not available unless your claim is
denied. Sometimes, though, if you ask the reviewing doctor for a copy
of the report, he or she will send you one. Additionally, some insurers
will forward a copy of the report to your physician/s for their comment.
You may be able to obtain a copy through them.
Take advantage of our free consultation to get information that applies
to your unique situation. Call ERISA Law Center today at (844) 710-2993.