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What Happens After an IME Exam?

Osterhout Berger Disability Law > Long Term Disability > What Happens After an IME Exam?

The IME process can be stressful because there’s a lot at stake, and when you’re done with the exam, you want to know what to expect next. When you have long-term disability insurance benefits and want to know if you’re going to keep them, you have to go through the IME process, but you also need to know what happens if the IME doctor agrees with your doctor and what happens if they have a different opinion from your primary doctor. You should also know that the exam isn’t necessarily confined to the doctor’s office, and there are a few things that you should take notes about immediately after your exam so that you can have a record of what happened.

What Is an IME?

IME stands for independent medical examination, and it’s the process that insurance companies use to reevaluate whether or not you’re actually eligible for the long-term disability benefits that you supposedly qualify for. During this process, a doctor looks at your previous medical records and does an examination on your to determine whether or not you fit the qualifications. The IME doctor could also order more tests to determine your health status. The doctor will then use this information to determine whether they agree with your personal doctor or not.

One of the most important things that a claimant needs to understand is that these medical exams aren’t as independent from the insurance company as they might sound. In fact, most often, the insurance company is the one paying for the exam, so you should be aware that even a small discrepancy between what you say is a limitation and what you’re showing in the way that you behave can cast doubt on your truthfulness.

When Is the IME Over?

You need to be careful when you leave the doctor’s office where your IME evaluation is done. More than likely, the doctor and other staff members will be watching the way that you act as you leave. For instance, if you came in with a limp and suddenly don’t have it when you walk out the front door to the clinic, there’s a good chance that the doctors are taking note of that, especially if this information affects your claim.

Additionally, if your condition would prohibit you from driving a car, walk up a flight of stairs, or do any other activity that you might need to do to get home, know that there might be someone watching you to see if you do these things. In fact, there might even be people from the insurance company surveilling you at your home, watching you as you walk inside your house. As a result, you shouldn’t consider the IME to be over until you are completely behind closed doors in your home. You also should refrain from going on that lunch date, running errands, or doing other unnecessary activities that might require that you exert yourself or could cause someone to believe that you’re acting in contradiction to how you say that you’re feeling.

Things to Note About the IME

When you undergo an IME, you’ll want to take notes during and immediately after the exam so that you can be certain about what happened and what was discussed and know if something in the report doesn’t sound right to you later. You might choose to take notes on a few important issues when you get to your car, or you might choose to wait until you’re home if you live near the doctor’s office.

Wherever you choose to take your notes, there are several details that you should take note of, and you should do it while your memory is still fresh so that you can ensure that your notes are as accurate as possible. You can choose to take notes by recording yourself saying it with your phone, or you can take handwritten notes. But if you choose to take notes with pen and paper, take a picture with your phone, too, so that you have a time-stamped record of when you wrote those notes so that it’s less likely that someone can accuse you of having forgotten and taken inaccurate notes.

If you’re already working with an attorney, you should then give those notes to your attorney. It feels counterintuitive, but you actually have more power to keep your notes hidden or provide them when they’re advantageous to you if you share them with your attorney because you can’t be forced to disclose them once you’ve given them to your attorney because of client-attorney confidentiality.

There are several things that you should take note of. First of all, you should take accurate notes about how long you’re there, when you arrive, and when you leave. Some other details to note include how long you were in the waiting room, if there were any other patients waiting with you, details about any paperwork you were asked to fill out, what questions the doctor asked you, your general impressions, any information that the doctor shared with you, and anything unusual that you noticed. (You can read more in our guide to handling an IME.)

The Scenarios

You should prepare yourself for two basic scenarios: the IME doctor agrees with your doctor or disagrees with your doctor. If the IME doctor agrees, you might wonder if that means that you’re free and clear and will continue to receive the benefits that you were set to receive before you were asked to complete the IME. For the most part, this is true. If the IME doctor agrees with your doctor in terms of the treatment that you’re receiving and your overall abilities and disabilities, your employer will act in accordance with what the IME doctor has proposed for your treatment in the workplace. On rare occasions, an arbitrator will need to get involved to enforce a decision because either the employer or the insurance company is not willing to go along with what the IME doctor and your doctor both agree on.

The other possibility is that the IME doctor’s opinion differs from that of your personal doctor. In this case, the insurance provider can stop paying your claim. The insurance company can also authorize your employer to accommodate work restrictions so that you can continue to work with modified arrangements, or they can also say that you need to have additional treatments before you can be considered for benefits again.

There might also be an arbitrator, who will decide whether the IME doctor or your doctor is more credible. Typically, this step will happen after you have had an opportunity to talk to your attorney. Additionally, if you don’t agree with the IME doctor, you might be able to challenge their decision if they made it based on incomplete, incorrect, or outdated information. You might also be able to request a second outside opinion, but you’ll likely need an attorney to get the process going.

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