Tips to Know Before Your Independent Medical Exam

Key Takeaways

• An Independent Medical Examination for a disability claim is supposed to be objective but is usually not.
• Most insurance companies will require an IME for a disability claim.
• Your treating doctor and IME doctor are different. The insurance company usually chooses the IME physician.
• IME doctors in New York and other states often use tricks to help insurance companies deny your claim.
• Discuss an upcoming IME with an experienced disability lawyer before attending.

If you are injured and filing a long-term or short-term disability claim through your policy, the insurance company will most likely require an IME. The IME doctor, often referred to as a medical consultant, will create a report based on the exam and submit it to the insurance company, which can then approve, deny, or terminate your claim. However, the problem is that the insurance company pays the IME medical consultant, who will “side” with the insurance company. These exams are supposed to be objective, but the medical consultant employs tactics in New York and other states to “help” the insurance company deny your claim. Seeking the help of a disability claims attorney at the Law Office of Justin C. Frankel, P.C. can help you navigate your case. Contact our firm at 888-583-4959 or fill out our online contact form for a free consultation to see how we can assist with your disability claim.

What is an Independent Medical Examination (IME)

A disability “Independent Medical Evaluation” describes the physical examination that a disabled claimant is asked to undergo by the insurance company who will then rely on the report to approve, deny, or continue your claim. The requirements for an IME are based on the provisions in the disability policy, and there may be some instances where the claimant does not have to comply with the request for an IME, but most policies and jurisdictions require an IME. Many problems are associated with IMEs, resulting in numerous lawsuits brought by individuals concerning these examinations, including one heard by the United States Supreme Court. The most crucial issue is that they are anything but independent.

The insurance company pays the medical consultant conducting the examination. Medical consultants who report that claimants cannot return to work based on their examination are unlikely to be retained repeatedly by the insurance company. Medical consultants who report that claimants can return to work will give the insurance company the information needed to deny or terminate a claim and, in return, are retained to perform more IMEs. There are entire medical practices that do nothing but IMEs for insurance companies. It’s a highly lucrative business for the doctors.

For claimants, the IME is a minefield that must be navigated carefully to avoid falling into traps.

What Do You Need to Know Before Going to an Independent Medical Examination (IME)?

Unless retained counsel advises you otherwise, you must attend the IME. There are numerous requirements, such as the proximity of the examining doctor’s office and their qualifications.

• Do not go alone to the IME. Bring a trusted friend or a family member, and insist they accompany you into the examination room. You may have to be assertive, but you should only go into an IME exam room with a witness.
• Record the IME, even if the medical consultant may not like this. An experienced disability insurance attorney can advise you based on the insurance policy and the laws governing your state.
• The insurance company is paying the medical consultant conducting the exam; no matter how friendly or kind, they are not on your side.
• If you are asked to do something that you cannot do, let the medical consultant know.
• If the medical consultant insults you by saying that you are unwilling to move in a particular way or calls you a malingerer, request that this be documented, as the entire IME may be considered flawed.

The IME is an opportunity for the insurance company to gather evidence about you and your medical condition for use against you in an appeal or a court of law.

What Are the Dos and Don’ts of an Independent Medical Examination?

During an IME, you should be careful of what you say and do. The medical consultant has already spoken with the insurance company and knows the desired outcome. These dos and don’ts can help with your exam.

Do

• Discuss your Independent Medical Exam with your disability attorney before attending the IME.
• Be honest about the severity of your injuries or disabilities. If you lie about your injuries, you may damage your case.
• Although you should be careful of what you say to the medical consultant, you can still be patient and friendly. How you present yourself in an IME is important. Additionally, dressing appropriately can help you appear more professional and serious about your claim.

Don’t

Some of the things you should never do during an IME include:

• Lie, change the description of your injuries, or overstate your injuries. When you change your story regarding the pain you are in, you can cause the doctor to disregard what you are saying.
• Give more information than what the medical consultant requests. The more you talk, the more insurance companies can manipulate what you say to deny your claim. Answer the medical consultant’s questions as directly as possible without discrepancies.
• Ask for a diagnosis or the medical consultant’s opinion. The IME medical consultant is not diagnosing or treating you. They are only there to answer specific questions from the insurance company for your disability claim case.

Hidden Dynamics Between Independent Medical Examinations and Insurance Companies

The medical consultant has likely already been provided with the insurance company’s file and knows the insurance company’s desired outcome before you even step into their waiting room. In some cases the insurance company provides the IME consultant nothing, so they have no idea what the case is about. The only thing the consultant knows in these situations is that they were hired by the insurance company to perform the IME with the predetermined goal of denying or terminating the claim.

The medical consultant may also have information regarding the amount of your monthly benefit, something that is entirely unnecessary and should be unethical for them to know. The IME is one in a long series of events that the insurance company will undertake as it seeks to find ways to avoid paying claims.

Your goal must be to protect yourself at all times throughout this process with an experienced disability insurance lawyer and a primary care physician whose priority is you so that you can focus on healing or learning to live with your disability.

What Happens After the Independent Medical Examination?

Going through the disability claim process is always a challenge. The insurance company and its medical consultants constantly challenge you by disputing your claims for disabilities caused by your work. This often forces people to return early to work or leave their jobs altogether. Seeking legal help from a disability claims attorney before you file a claim for long-term disability insurance benefits or even short-term benefits can help make the process smoother.

Once you file a claim for disability insurance benefits, you may receive some correspondence from the disability insurance company advising you that your claim is being reviewed and asking for some additional information.

The insurance company may require you to attend an IME to receive disability benefits. The IME is used to challenge your disability claim.

During the IME, you can expect:

• A 15 to 20-minute cursory exam that answers specific questions the insurance company has about your injuries by a medical consultant hired by the insurance company.
• Completing a medical history form.
• The medical consultant reviews documents provided by your treating physician (in some cases).
• The examining medical consultant will ask questions about your symptoms, previous treatment, and whether your condition is improving.
• Recording impressions in writing or via a tape recorder regarding the extent of your disability and what treatment you have or need.

Once the insurance company receives the IME report, they might terminate your disability claim. If your claim is denied or terminated, it is time to call the legal team at the Law Office of Justin C. Frankel, P.C.

Why Our Clients Trust The Law Office of Justin C. Frankel, P.C.

You don’t have to go through a disability insurance claim alone. Our clients choose us for our experience and our results. Despite disability policy and fact patterns differing from case to case, our experience and aggressive representation of our clients have led to many successful outcomes. We have overturned denials for clients at all stages of their claims and even won back benefits after terminations. Whether you are about to file a claim or had one recently denied or terminated, contact the disability insurance attorneys at the Law Office of Justin C. Frankel, P.C.

Testimonials

“Mr. Frankel was recommended by my financial team. Working with his firm was a great experience. They were responsive and always available for issues. My claim was handled efficiently with a very good result. If you’re in need of representation dealing with the insurance company give him a call you won’t regret it.” – Vito C.

“I have been a client of Justin Frankel for 8 years. From my very first, tearful phone call to him, Justin offered compassion and kindness. He expressed interest in my case. I was reassured by his confidence in his expertise. Justin won my disability appeal and has continued to represent me, acting as a buffer for me against the insurance company. If you are struggling with your disability claim, I strongly recommend giving Justin Frankel a call.” – Mary K.

Don’t Let the Insurance Company Take Advantage of You

Contact the Law Office of Justin C. Frankel, P.C., at 888-583-4959 for a free consultation and guidance through your disability insurance claim and the IME exam. You will work directly with an experienced partner, not an associate. You can also contact us via our online contact form.