If you have filed a claim to recover your long-term disability (LTD) benefits, the first thing your LTD insurance company will do will be to open an investigation to analyze the extent of your claimed disability and the limitations it puts on you. Part of this investigation may be a request from your LTD carrier that you undergo an “Independent Medical Examination” (IME) by a claimed “impartial” medical professional to examine you and assess the extent of your physical limitations. This is done through a medical examination and an analysis of your medical records. The purpose of these exams, the insurance company will claim, is to “objectively” evaluate your medical condition without the bias of a doctor/patient relationship. However, do not forget who is paying the “independent” professional to examine you. That is the insurance company.
3 THINGS TO KEEP IN MIND ABOUT IMES
1) THE DOCTORS ARE NOT INDEPENDENT
In theory, IMEs are intended to flush out the extent of your medical issues so the insurance company can determine whether you are, in fact, disabled and entitled to LTD benefits. For this reason, the insurance companies often use IMEs to try to reduce or eliminate the scope of your injuries to limit the amount of money they have to pay on your LTD claim. They do this by hiring a medical professional to examine you who is trying to find medical support for a diagnosis that works against you and your LTD claim. For example, if a hand injury you recently suffered has hindered your dexterity and ability to perform surgeries, the insurance company responsible for paying your LTD benefits may ask that you undergo an “independent” medical examination by one of their hired medical professionals in the hopes their doctor will find you do not in fact suffer from the dexterity limitations you claim and there are other surgeries you can still perform. This way the insurance company does not have to pay as much on your LTD claim. It is important to remember the physicians hired by your LTD carrier are not concerned with your medical well-being and will never offer you any medical advice. Their goal is to attack your credibility and the credibility of your primary care physician. Some examiners work exclusively for insurance companies, but they are not obligated and, therefore, often will not tell you that.
2) YOU HAVE THE RIGHT TO RECORD THE IME
What is the best way to ensure your IME in your long-term disability claim is conducted fairly? Having both sides present and having the examination recorded. You should never have to give up your rights so an insurance company can exercise theirs. In most cases, you have the right to have your LTD attorney present to ensure the examination is fair and accurate and to protect the integrity of the examination, i.e., both by recording it and standing witness. If the examination is not recorded and the medical professional hired by your LTD carrier does not conduct a thorough examination (for example, assume he does not even examine the site of your injury), you may have no way to prove later, when that doctor claims your injuries are not as extensive as you say, how poor his examination was because you did not exercise your right to have your attorney present and have the examination recorded.
3) EXAMINATIONS ARE MOST OFTEN USED TO DENY CLAIMS
You may not be obligated to even undergo an IME. While, generally speaking, if you are asking an insurance company to pay you your long-term disability benefits, the company has a right to investigate the scope and extent of your injury; however, they do not have a right to subject you to examinations of conditions you are not seeking compensation for. In some cases, these IMEs are just attempts to badger or harass claimants who suffer from a disability in order to gain advantage. The classic example of an unnecessary and harassing IME is one requesting a psychological evaluation of a person with a disability who has no history or indication of mental disease or disorder. Do not submit to an IME of any type before speaking to a long-term disability insurance attorney.
Also, when undergoing an IME, it is important to remember to never volunteer information unless asked. Everything about you—from your clothing to your demeanor to your statements—will be documented, scrutinized, and reported to your LTD insurance company. Having an experienced attorney on board to prepare you for the process will help you protect your interests.
CONTACT AN ATTORNEY IF YOU ARE ASKED TO UNDERGO AN IME
The premier long-term disability denial lawyers at Taylor, Warren, Weidner & Hancock have years of experience dealing with long-term disability benefits denials, as well as the ins and outs of insurance companies and the great lengths they will go to to deny an LTD claim. We never charge any fee or cost to inform you of your rights when pursuing a LTD claim. If you believe you are suffering from a disability that impacts your ability to perform your job and your LTD insurance carrier is causing delay on the claim or harassing you or your treating physicians, give us a call today at (850) 438-4899. Our attorneys are here to help and answer any questions you may have.