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ERISA Law

Independent Medical Exams (IME) for Long-Term Disability Claims

August 1, 2020
smiling male patient undergoing independent medical exam (ime) with doctor in exam room

If you are receiving long-term disability (LTD) benefits, the insurance company will periodically review your claim to determine if you continue to meet the applicable definition of disability.  Often, this will involve obtaining your medical records and forms from your doctors to be reviewed by a nurse or doctor who works for the insurance company.  However, sometimes, the insurance company asks you to attend an independent medical exam, or IME, in order to determine what your functional impairments are and thus whether you continue to meet the definition of disability.  However, although these exams are labeled “independent” and performed by someone outside of the insurance company, there are several things you should be aware if your long-term disability insurer wants to send you for an IME.

Is an Independent Medical Exam (IME) Actually Independent?

Although IMEs are labeled “independent,” in most cases the doctor performing the exam is not truly independent because the insurance company is paying for the exam.  If the doctor performs a large number of IMEs, and thus derives a substantial portion of his income from insurance companies, he may be incentivized to keep insurance companies happy and help them avoid paying long-term disability benefits.  Unfortunately, this can result in biased exams and reports that do not accurately reflect your medical condition and impairments.

You can request the medical provider’s curriculum vitae (CV) prior to the IME appointment.  The provider’s CV may indicate that the provider completes these exams regularly for insurance companies. This could be indicative that the provider is more likely to find you not disabled so that he can acquire additional work from the insurance company.  Although regularly conducting IMEs is not a definitive indicator that the provider will be biased, it is important to keep in mind.  You should consider contacting an attorney if the insurance company wants you to attend an IME and you are concerned about the exam provider’s neutrality.

Is an IME Appropriate for My Disabling Condition?

There are some instances in which an IME may not be appropriate for your disabling condition.  Typically, IMEs are brief – the physician will interview you about your medical history and perform a short physical exam.  For many claimants, that one-time, brief exam is not sufficient to fully and accurately determine their functional impairments.  However, this is especially true if your disability is due to conditions that cause chronic pain or fatigue, such as fibromyalgia or chronic fatigue syndrome.  Often with these conditions, you are able to perform some activity but not on a reliable and consistent basis for several hours per day or multiple days per week.  Thus, the brevity of an IME will not accurately reflect your functional impairments or ability to work.  Unfortunately, most insurance companies do not consider whether an IME will accurately reflect your disability when they ask you to attend one.

What Can I Do to Try and Make Sure My IME Is Fair?

Before you attend the scheduled IME, you should gather your medical records on your own and bring them to the appointment to ensure that all of the relevant information is being presented to the doctor.  You should not rely on the insurance company to send the appropriate medical records.  Failing to provide the doctor with medical records yourself can result in the doctor having a skewed evaluation of your past medical history.

To further ensure that the appointment is as unbiased as possible, you can request to bring a witness to the exam who can later attest to the contents and results of the appointment.  Additionally, you should request a copy of the doctor’s report following the exam.  This will allow you to identify any discrepancies between what occurred during the exam and the report the doctor submitted to the insurance company.

Can I Decline to Participate in an Independent Medical Exam?

Generally, if the insurance company asks you to attend an IME, you must do so. Most long-term disability policies have provisions which require that you cooperate with the insurance company in their assessment of your claim.  As a result, declining to participate in the IME could cause your claim to be terminated or denied.  You can sometimes argue that an IME should not be necessary and that you have provided enough medical documentation for the insurance company to make a decision, but if the insurance company continues to insist that you attend the IME, refusing to do so could jeopardize your claim.  You should consider contacting an attorney if you are being scheduled for an IME and think you have already supplied enough information.

Contact CCK

At Chisholm Chisholm & Kilpatrick LTD, our team of experienced attorneys and professionals has assisted clients throughout the long-term disability claim process.  We understand that being scheduled for an IME is stressful and can potentially jeopardize your claim.  If your long-term disability insurer has scheduled you for an IME and you are concerned about the impact it will have on your LTD claim, contact us now at (401) 237-6412 for a FREE consultation to see if we can assist you.