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Independent Medical Examinations Explained

Osterhout Berger Disability Law > Long Term Disability > Independent Medical Examinations Explained

Some people are unable to work for a long period of time but don’t qualify for worker’s compensation. At times like these, many people apply to receive their long-term disability insurance claim. If you were recently awarded long-term disability insurance, your insurance provider might want a separate exam called an IME. This test is used by insurance companies to determine whether or not someone meets the criteria for the disability claims that they’re saying they do, and you should know more about what the IME if you’re being asked to complete one because it can alter the outcome of the benefits that you receive on a monthly basis.

What Is an IME?

An IME is an independent medical examination, and they’re common for people who are on long-term disability insurance. You might have qualified for disability insurance in the past by going to the doctors of your choosing, but the insurance company wants to ensure that you continue to meet the qualifications for the condition under which you’re receiving benefits. To ensure that you still meet the qualifications for benefits, you’ll need to undergo an independent medical examination so that they can be certain that you’re health status still meets the qualifications. You might also be asked to undergo an IME if your insurance company disputes the original findings of the doctor or doctors that you went through to get your diagnosis. During this exam, the doctor will not only evaluate your current condition, but they’ll also look at the course of treatment that you’ve received to determine whether or not you’ve received proper care.

The outcome of this examination isn’t the only thing that will factor into how much you receive in disability benefits, but it can weigh heavily, so it’s in your best interest to do as much as you can to ensure an outcome that’s in your favor. Additionally, the doctor’s office isn’t owned by the insurance company, which is why they call it independent, but the insurance company is the one that’s paying the doctor.

Who Chooses the Doctor?

The rules on who selects the doctor and the overall rules about the exams are complicated, and they can vary from one state to the next. Generally, though, if your insurance company asks for an IME, they will choose the doctor. This is often not in the best interest of you as the benefit recipient because the doctor could slightly modify the results, whether intentionally or unintentionally, to downplay your symptoms. But if you don’t agree with the results that you received from the IME doctor, you should check your state’s rules because you might be allowed to request a reassessment, at which point you would be able to choose the doctor.

Is an IME Truly Independent?

The reality is that even though an IME is labeled as independent, this isn’t entirely the case because the doctor is being paid by the insurance company, so the doctor still technically knows that the insurance company is the one that’s paying them. Unfortunately, especially if the doctor is deriving a large portion of their income from the insurance company, they’re more likely to want to keep said insurance company happy by allowing people to go back to work rather than What’s really negative about this is that when these doctors are influenced by the fact that the insurance companies are paying their bills, you get a less accurate assessment. Your insurance provider might be the one to make the decision about who you go see. (Read more in our guide to handling an IME exam.)

One thing that you can do to prepare is to request a copy of the medical provider’s curriculum vitae, which will list whether or not they do these types of exams regularly. If you find out that the doctor that your insurance company wants to send you to does these exams on a regular basis and are concerned that they’re not going to be neutral throughout the process and with their assessment, you can contact an attorney to review your case and see if there are alternate solutions.

Can I Decline to Have an IME?

If you’re being asked to attend an IME by your insurance provider and you intend to continue receiving benefits, you have to go to the exam. There might be times when you can decide to say that they should have enough medical evidence to make a claim, but you also run the risk of having more difficulties getting your benefits, and they might ultimately decide to deny you.

Usually, there are provisions in the policy that state that you’re required to participate in the assessment of your case, and going to the IME is included in being cooperative with the evaluation process. You can also contact an attorney if you think that you’ve already supplied more than enough information so that you can learn more about what you can do about assessments that you feel are excessive.

What Happens During an IME?

Before the IME even starts, your medical records are sent to the doctor who will be doing the IME. The insurance company might also send an accompanying letter that tells the doctor more about your condition, any treatments that you’ve received, and any hotly contested issues involving your condition and claim. This is used to frame your case for the doctor.

The IME doctor might also ask some specific questions of you when you get there. For instance, they might ask you if you actually have the condition that you say that you have, meaning that they want to know if you were correctly diagnosed. They might also want to know what kind of additional treatment you need. For instance, they might need to know if you need surgery and whether or not it’s actually an appropriate course of treatment. They might also ask how long you’ll need to be on leave from work and whether or not you need any restrictions to go back to work. They might also want to know if you have any other permanent disabilities.

When you get to the IME doctor’s office, you should ask to see any accompanying letter that the insurance company might have sent. You want to review this so that you can correct any factual errors that might be in the letter.

It’s also important that you’re aware that the same doctor-patient confidentiality that you’ve come to expect from your primary care physician will not apply in this scenario. In fact, the doctor will report back to your insurance company anything you tell them and anything that they find out that’s relevant to your condition that they find out during the course of the examination.

The doctor will ask you questions about the type of condition that you have and other factors that affect your condition and ability to work. The doctor might also conduct relevant tests to determine how much your condition affects your ability to work and even which symptoms you have and how bad they are.

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