What Should I Know About a Disability Insurance Medical Exam (IME)?
As part of an ongoing disability insurance claim, it’s common for an individual holding the policy to submit to a “disability insurance medical exam.” Typically referred to by its acronym, IME, it’s basically an independent examination by a physician who is hand-picked by the insurance company or its third-party vendor. Many choose to call it a “compulsory medical exam” because policyholders attempting to claim disability benefits frequently have no choice but to attend this examination.
In many instances, the entire policy could be voided and the claim denied if the disabled claimant fails to appear and undergo evaluation. Since this is a crucial part of receiving the disability benefits you’ve paid for with the policy, it’s absolutely vital to know what to expect and how to conduct yourself within this somewhat stressful scenario. Disability attorneys Greg Dell and Cesar Gavidia share some important tips and advice on how to protect yourself while making the most of this pivotal part of the process.
What to Expect in an IME Exam
Before ever stepping foot into the physician’s office to undergo an IME, there are some fundamental things to understand. Disability lawyer Cesar Gavidia explains that he and others at his disability insurance law firm consider this an adversarial type of proceeding. That’s because this medical consultant or “expert” has been specifically selected and paid a lot of money to do potentially countless exams like this to benefit the insurance company.
“… This doctor may be an examiner consultant that the disability insurer has used many, many times,” states Cesar Gavidia. “And that could mean that this doctor may have a particular bias in favor of the disability insurer.”
It’s important to maintain a pleasant demeanor and avoid being combative or confrontational with the independent medical examiner, as this could raise suspicions and cause the examiner to question your motives or answers. This can be difficult, especially if you realize that the physician hasn’t even bothered to read your medical records before beginning the examination. Cesar Gavidia stresses that you should just proceed with the examination in a professional manner, similar to how you would approach a consultation with your own physician.
Discussing Your Medical History
Since the medical examiner in an IME may not even know why you are there, it’s often the case that they haven’t yet reviewed your case and may be relying only on what you tell them at that moment. You may be there for a neck condition, an arthritis issue, back problems or any other number of disabling conditions – but this new examiner may be totally unprepared beforehand.
“I find that 50-50 they’re prepared and 50-50 they’re not,” states disability attorney Greg Dell. “So how much should the claimants who are going in there be responsible to educate the physicians about their medical history?”
Not at all, according the attorney Cesar Gavidia. This isn’t an IME that the policyholder has requested or a physician that is of their choosing. It’s one that the insurance company has asked for. So, it’s the responsibility of the disability insurer to educate the IME doctor. This puts the onus on the insurance company to send all the complied medical records related to your claim, educate the physician, and tell him or her what to be looking for with the specific patient.
This is where the disabled claimant must be careful about what kind of information to volunteer, explains Greg Dell. As a disability insurance attorney representing the claimant, he would always be thinking about protecting the client but also thinking: What if they deny that claim? How are we going to prosecute the claim and go after the faults of the insurance company? One of the best ways to do that, he says, is for the claimant to basically answer that is asked but no volunteer new information or things that are not directly asked.
It is not the job of the claimant to sell his condition to the doctor. In fact, if the doctor does a poor job and doesn’t consider of the medical records, never asks specific questions to the claimant, or doesn’t have him bend or do different types of tests, this works in favor of the disabled policyholder. Assuming the claim is later denied, it helps bolster a future appeal or lawsuit if the doctor never questioned, explored or documented the patient’s complaints.
This could help prove that the doctor’s review was unreasonable. Cesar Gavidia further explains that this gives credence to claiming there was a lack of reliability in the report and that the disability insurer, therefore, acted wither arbitrarily or capriciously in deciding the claim.
Assume Surveillance Before, During and After an IME
In addition to the physician potentially looking for inconsistencies during the IME exam, a claimant must assume that he’s being watched prior to and after the exam as well. Cesar Gavidia stresses that it is quite common for a claimant to be under surveillance by a private investigator, either days before or just prior to an IME.
During the exam, it’s important not to exaggerate your symptoms or wear every brace and wrap available. But realize that they may well be watching you from the time you get out of your car, monitoring how you move about the office, and how you get on and off the table. They will also be doing what are called Waddell signs on a test, which are designed to expose exaggerations. These are tests that should cause no discomfort whatsoever, so will raise a red flag if the claimant states that they do.
What Is the Actual IME Exam Like?
The actual IME exam should not be invasive in any way. Depending on the type of IME required for your disability, the doctor may ask you to stand, walk, bend or do other movements that reveal what is physically uncomfortable for you. If it’s a “functional capacity” examination, they will be measuring your ability to perform certain physical functions that may be related to your ability to work.
A doctor may ask you to submit to an X-ray or MRI, but this is almost crossing into the area of medical treatment, according to Cesar Gavidia. The examiner in this scenario is not there to diagnose or treat a problem, but rather to assess whether the person has a long-term disability (LTD) and suffers from physical functionality restrictions or limitations.
Documenting the Exam
Attorney Greg Dell addresses the issue of how to protect the veracity or truthfulness of what goes on at the IME exam and whether it’s legal to record audio or video of the procedure. Cesar Gavidia notes that it’s always best to request and receive consent from the insurance company ahead of time, which is something that a disability insurance law firm such as Dell & Schaefer will arrange on your behalf.
Depending on which state you are in, it may be legal to record audio on your own without the consent of the person being recorded. This comes down to whether you live in a one-party consent state or a two-party consent state. It’s quite possible that you can legally record the entire interaction with only your own consent, as long as you are one of the parties to the conversation.
This can be invaluable evidence if your case later ends up in an ERISA appeal lawsuit over a denied disability claim. Another option is to bring along a spouse or other observer who can take notes and bear witness to what occurred during the exam.
The main thing is to be fully prepared for the IME when dealing with a disability insurance claim denial. Be prepared, understand your medical records, know what you’ve previously told your doctors, and know your weaknesses. A disability insurance attorney at Dell & Schaefer is fully prepared to help you through the process and ensure a successful result. They represent clients in any U.S. state and the initial evaluation is always free.