Do you have a claim or are you receiving long term disability benefits and your insurance company has told you it wants you to go to an “Independent Medical Examination” (“IME”)?
What You Need to Know About an IME
Thousands of people in America have long-term disability insurance. For the most part, such insurance is provided by or through a person’s employer. Most such claims are subject to a federal statute known as ERISA (Employee Retirement Income Security Act).
Virtually every insurance policy which provides long-term disability benefits allows the insurance company to have you examined by a doctor of its choice as often as it deems necessary. Nearly all policies also state that if you fail to cooperate and refuse to attend an Independent Medical Examination or IME at the request of the insurance company, it can terminate your benefits.
As a practical matter, if your long-term disability insurance company wants you to attend an Independent Medical Examination, you do so because your refusal will almost certainly result in your disability benefits being denied or terminated.
Why is the Insurance Company Sending Me to an Independent Medical Examination?
If you have just applied for benefits and the insurance company is still evaluating whether to pay or not, it may be that your medical condition is so complicated that the insurance company wants its own doctor to examine you.
If you have received long-term disability benefits for a while and the definition of “disabled” under your policy is about to change, the insurance company may send you to an IME to determine whether or not you are still disabled under the less strident definition of disabled in the policy.
If your claim has been denied or terminated and you have submitted an appeal, it has become very common for insurance companies to send claimants to an IME as part of its appeal review process.
If you have been on benefits for a long time and your insurance company suddenly asks you to attend an IME, it is possible, even likely, that it is looking for reasons to terminate your benefits.
No matter when you are asked to go to an IME by your long term disability insurance carrier, you should go. But, you should also be aware that insurance companies commonly conduct secret surveillance of claimants on the days before, on the day of, and on the days after such a medical examination. Since the insurance company has scheduled the examination, it knows that you will be leaving your house and it knows where you will be going.
It is likely that a private investigator will be hired to watch you and videotape your activities while you are walking to and from your car, driving to or from the IME, and times when you are outside and in public.
Therefore, if you go shopping or out to lunch as part of the trip to or from the IME, the insurance company may claim that such activity proof that you can work.
Will the Doctor the Insurance Company Hired for the IME Be Fair to You?
It depends. Some of the doctors who work for insurance companies and conduct Independent Medical Examinations are the same specialists whom your own doctor would refer you to for a second opinion or for a specialist evaluation. Those doctors are often very good and provide useful services and fair reports.
But there are also other doctors who work for insurance companies who sometimes have histories of professional misconduct, have been disciplined by the medical boards, are unqualified, have long records of writing one-sided opinions for insurance companies, or are otherwise unfair.
Likely, you will not know what kind of doctor has been hired to examine you until after you see the doctor and/or the report. Sometimes even an honest doctor “produces” a dishonest report. Most of these independent medical examination doctors are not hired directly by the insurance companies but are hired by third-party services which review and “correct” the doctor’s report.
Sometimes, the doctor writes one thing in his/her report and the service changes it without the doctor’s knowledge. You may never know because the only version of the report you will ever see is the final version the service provides to the insurance company, not necessarily the version the doctor provided to the service. An experienced ERISA attorney often notices details in the report that calls its authenticity into question and thereby providing another argument against the denial or termination of your disability benefits.
The Importance of an Independent Medical Examination
If you are being asked to participate in an IME as part of your long-term disability benefits claim you should keep the above information in mind . Your claim for long-term disability benefits are likely to be denied or terminated if you fail to attend, and, your activity level surrounding the day(s) of the IME are likely to be recorded.