ERISA • Employment Law

Do I Need to Attend an Independent Medical Exam?

24 Jul 2018

After an employee makes a long term disability claim, the insurance company often requests an independent medical exam (IME). During the IME, you will be examined by a doctor chosen by the insurance company. If this sounds a little suspicious, you are right for being skeptical. Often, insurers use IMEs to deny disability benefits by having their doctor minimize your disability. Read on for more information about how to handle your IME.

Why Insurers Like IMEs

An IME gives an insurance company a chance to dispute that you are sufficiently injured to qualify for long term disability benefits. Furthermore, by picking the doctor, the insurance company can send you to someone they know will issue a medical report unfavorable to you.

Admittedly, in a few situations, your medical condition might be so complicated that insurance companies really want to fully understand what is wrong with you. However, in a large fraction of cases, the insurer simply does not like the prognosis your own doctor has given and wants an opinion that lets them deny you benefits.

You Have to Attend

Most insurance policies contain a clause giving the insurer the right to terminate the policy if you refuse the independent medical exam. However, you should certainly double check your policy. It might also contain important information about your obligations during the IME, which you also must follow. If you do not have a copy of your policy, contact the plan administrator to obtain one.

You Will be Filmed

There is a good chance that the insurance company will hire a private investigator to film you in the days before and after your IME. These investigators are gathering evidence to use against you. For example, if you claim that you can barely leave bed but are filmed playing with your children outside, then the insurance company has a legitimate reason to deny you benefits.

However, injured employees should realize that these tapes will be used selectively. You might struggle to get to the end of your driveway to pick up your mail, but the insurance company will use a two-second clip that makes it look like you move with ease. Be careful about being seen outside in the days before and after your examination.

Prepare Properly

If you must attend your IME, then you should take steps to protect your rights. For example, you might choose to:

  • Have a friend or family member attend with you. This is an important witness who can testify about whether the doctor performed a full and fair examination.
  • Say as little as possible during the examination. Some doctors might try to pump you for information to use against you.
  • Request information from the insurance company about how many employees they refer to this particular doctor. A high number of referrals might suggest the doctor is a “hired gun” who the company trusts to minimize your injuries.

Worried About an Independent Medical Exam? Speak with a Philadelphia Long Term Disability Lawyer

Some IMEs go off without a hitch, but it is best to be prepared for a negative doctor’s report. An attorney can review any doctor’s report and punch holes in it, strengthening your claim for disability benefits.

At The Garner Firm, we help injured employees get the disability benefits they deserve. To schedule your free consultation, please call 215-645-5955.

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Mr. Garner is an ERISA employee benefits and employment attorney with over a decade of experience. The laws governing employee benefits, the employment relationship, and the workplace are complex.

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