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