What To Expect From An Independent Medical Examination (“IME”)
At any stage of the long term disability claim process, your insurer may schedule you for an Independent Medical Examination (also known as an “IME”). An IME is an examination done by a physician of the insurer’s choosing. The IME physician will then write a report for your insurer evaluating your condition and stating whether you are capable of working.
Despite the name, IME physicians are not truly independent or neutral. Many IME physicians perform hundreds to thousands of examinations for the insurer on an annual basis, meaning they are effectively on the insurer’s payroll. As a result, they have an incentive to discredit your disability.
However, there are steps you can take to prepare yourself before, during, and after an IME.
Below we’ll answer common questions regarding IMEs and long term disability insurance claims.
Why does my insurer want me to undergo an IME?
If your insurer believes that an IME report will be worth the expense of the doctor’s fee, it will schedule an examination. Your insurer may schedule an IME with one of their providers if:
Remember that IME physicians are hired by your insurer. This creates a direct conflict of interest. An IME physician is motivated to invalidate your symptoms and diagnosis. It is no surprise that IME reports are frequently unfavorable to the claimant. This in turn gives your insurer justification for closing your disability claim.
Being scheduled for an IME may be a sign that your insurer is looking for cause to deny or terminate your disability benefits. While undergoing an IME doesn’t guarantee your disability claim is doomed, it is certainly reason for alarm.
Can I refuse or cancel my scheduled IME?
If your insurer demands you undergo an IME, you must comply, or you risk benefit denial or termination. Unfortunately, the terms of your long term disability policy likely give your insurer the right to request an IME at their discretion.
The best way to avoid an IME in the first place is by remaining in regular treatment. You should continue to submit documentation of your disability to your insurer as you seek treatment from your providers. Your insurer will require ongoing evidence of your condition to continue benefits. A lack of evidence can lead to your insurer requesting an IME.
It is difficult to get an IME canceled, but it is by no means impossible. The best way to avoid a scheduled IME is to submit new evidence of your condition to your insurer. This could mean recent office visit notes or testing results from your doctors. If you have objective, irrefutable evidence of your work restrictions and limitations, your insurer may decide that an IME is not worth the expense.
An IME may also be canceled if the evaluation requested will put your health at risk. If this is the case, consider asking your doctor to provide a letter giving the opinion that the IME is a threat to your health or safety.
Your insurer may accept the above and cancel the IME voluntarily. However, the policy likely does give them the right to demand you undergo an IME regardless. If you refuse to attend the IME appointment, your insurer can subsequently deny or terminate your disability benefits for failure to meet the agreed upon terms of your policy.
What will happen during an IME?
Typically, IME examinations are brief and perfunctory. Often the IME physician will neglect to review your medical records and only rely on a summary of your condition supplied by your insurer. They may be wholly unfamiliar with your diagnoses and medical history. Sometimes your insurer will even send you for an IME with a physician whose expertise is unrelated to your medical condition.
During the examination, the IME physician may ask you questions regarding your condition and symptoms. As mentioned, the examinations themselves tend to be very cursory. You may only meet the IME physician face-to-face for a few minutes.
Afterwards, the IME physician will write a report for your insurer based on their examination. This report will provide their opinion regarding whether your medical condition prevents you from working. Your insurer can use this report as evidence when determining your disability claim.
Obviously, this practice can be problematic in many ways. First, the IME physician’s conflict of interest increases the likelihood they will provide your insurer a report that is unsupportive of your disability. Second, the IME physician may have only “examined” you for a few minutes. Third, they may have also neglected to take into account your existing medical records, treatment history, and occupational duties. For these reasons, it is all but impossible for an IME physician to render an objective, accurate verdict on your ability to work based on such limited framework.
What should I do if I have to undergo an IME?
Should you have to undergo an IME at your insurer’s request, there are steps you can take to protect yourself and your disability claim.
You must attend the IME.
It is very likely that your long term disability policy requires you to submit to an IME. If you do not attend, your insurer can deny or terminate your benefits claim. A denial or termination on this basis is extremely hard to undo. If, on the other hand, you attend the IME, and your benefits claim is denied or terminated, you may still successfully appeal that determination. An appeal would be based on additional evidence contrary to the conclusions of the IME and based on arguments regarding the inherent problems with IMEs outlined above.
Do not attend the IME alone.
IME physicians tend to distort the details of the examination. They may misrepresent what occurred or what statements you made. You do not want to be in a he said/she said situation. To avoid this, we always recommend our clients attend an IME with a witness. Ideally this will be a nursing professional familiar with medical examinations. However, a family member or friend will also suffice. Have your witness record their own notes on what occurs during the examination.
Don’t exaggerate your medical condition at the IME.
Undergoing an IME can be very stressful. You are likely (and understandably) concerned about your disability claim being denied or terminated as a result. You may feel desperate to prove to the IME physician the extent of your disability. However, be careful to remain truthful about your condition. Only bring assistive devices (such as a neck brace, cane, etc.) that you use more than occasionally. For example, if you bring a cane to the examination, but are later surveilled by your insurer without one, that can be damaging to your credibility.
Likewise, do not attempt to exaggerate pain, fatigue, or other symptoms. IME physicians are on alert to detect malingering behavior. Remember that you have nothing to hide. Just because your symptoms are not always visible does not negate their authenticity.
Be mindful of what you say and do during the IME.
From the moment you enter the examiner’s office, be aware you are under observation—possibly not only by the IME physician. The office receptionist, for instance, may be clocking your behavior in the waiting room. It is not unheard of for IME physicians to keep you waiting for long periods to test your sitting tolerance. Keep in mind that the IME physician will take note of everything, including how you walk into the room, how you sit on a chair, and how you climb on the examining table.
When answering questions from the IME physician, do not joke or be sarcastic. The IME physician may not know you are kidding and write down your response as serious. You do not want to give the IME physician any ammunition to twist your words out of context.
Record what happens during the IME.
During the IME, wear a watch and take detailed, time-stamped notes on your observations. This documentation can later be used to determine if the IME physician’s report is an honest representation of what occurred during the examination.
Be aware of surveillance around the time of the IME.
Sometimes long term disability insurers will go as far to conduct surveillance on their claimants. This can include in-person surveillance by a private investigator. The investigator may follow you by car to record you in public. One of the most common times in-person surveillance occurs is before, during, and after a scheduled IME. Your insurer knows the date and time you will be leaving your home to attend the IME, so they will use the opportunity to have you followed.
Typically, the in-person surveillance takes place over a few consecutive days. In the days leading up to and following your IME, exercise extreme caution when outside your home.
What should I do after undergoing an IME?
After undergoing an IME, you don’t have to sit around and wait to see if your benefits are denied or terminated. There are proactive steps you can take to protect your disability claim.
Write a statement.
As soon as the IME has concluded, write a statement of what occurred. It is best to do this while the experience is fresh in your mind. You can use the notes you took during the examination for reference.
Your statement can address the following:
- What did the waiting and examination rooms look like? Were they dingy and dirty? Crammed with people?
- How long did the IME keep you waiting?
- Who conducted the IME? Was it a doctor or a nurse?
- Did the doctor ask you any questions? If so, what did they ask?
- How long did the actual examination last?
- Did the IME know anything about you or your condition(s)?
- How did the IME physician treat you? For example, was the IME physician dismissive of you and/or your symptoms? Mean? Rushed? Disinterested? Judgmental?
- What sort of testing did the IME physician perform during the examination? How does this differ from how your treating doctor normally examines you? For example, maybe the doctor did not perform many of the tests that your treating doctor normally performs.
Likewise, your witness (whether a nursing professional, family member, or friend) may also write their own statement. This adds credence to your version of events.
Request the IME report from your insurer.
You can immediately demand a copy of the IME report from your insurer. We always recommend this request be made in writing.
Whether your insurer will provide a copy of the IME report is questionable. Sometimes they will state they do not have to share the report until a determination on your claim has been made. Still, your insurer may provide the report if requested.
Provide your insurer a rebuttal of the IME report.
If you have a copy of the IME report, you can see if the IME physician provided a supportive opinion of your disability. If they did not, you can ask your treating doctor to write a rebuttal addressed to your insurer.
The rebuttal should outline what the IME physician overlooked, what they may have misinterpreted, and whether the IME physician reviewed all of your medical records.
Get an attorney.
As explained above, your insurer sending you for an IME can be a red flag that they intend to deny or cut off your disability benefits. It may be in your interest to hire an attorney to help you navigate the IME and help refute the contents of the IME report.
In the next section, we’ll explain how a long term disability attorney can assist you with an IME.
How can a long term disability attorney help with an IME?
An experienced long term disability attorney can help you avoid an IME being scheduled. If you must undergo the IME, an attorney can help you throughout the process to avoid claim denial or termination.
Here are a few ways that the ERISA disability attorneys at Riemer Hess help our clients before, during, and after an IME.
Before the IME Takes Place
At Riemer Hess, we ensure our clients treat regularly with their providers. We also recommend and coordinate testing options for our clients. These evaluation reports can supplement and bolster a client’s disability claim. By continuously providing the insurer with updated medical evidence of the client’s ongoing disability, we can prevent an IME from being scheduled. IMEs are most likely to be scheduled when your insurer identifies a lack of evidence or noncompliance with treatment. They will be less inclined to waste the expense and effort in the face of ample medical proof.
Occasionally, a client will receive an IME demand from their insurer despite our best preventative efforts. A few of the tactics our attorneys at Riemer Hess use to cancel an IME include:
- Obtaining new testing or medical records before the IME. This new medical evidence is sent to the insurer with a request to cancel the IME. We argue to the insurer that the new evidence demonstrates our client’s disability, so the IME is not necessary.
- Getting a letter from the client’s doctor stating that the IME would unreasonably put the client’s health at risk.
- Arguing that the doctor specified to conduct the IME is unqualified to make an assessment of our client’s conditions.
We have successfully delayed or outright canceled scheduled IMEs for clients. However, sometimes the insurer will still insist the IME goes on as planned.
During the IME
At Riemer Hess, our disability attorneys routinely arrange for a nursing service to provide a nurse to attend the IME with our clients. This guarantees that a medical professional familiar with examination testing will be present. The nurse will write their own report detailing what occurred at the examination. Oftentimes the nurse’s report will provide proof that the IME physician’s report is inaccurate and/or incomplete.
We prepare our clients before the IME by explaining what to expect. We advise them to take detailed notes during and after the examination. Additionally, we explain what they should be looking out for and recording while undergoing the IME. This helps the client provide a comprehensive statement of what they experienced.
After the IME
Once the IME has concluded, our disability attorneys at Riemer Hess take quick action.
First, we work with the nursing service to obtain the witness report from the nurse who attended the IME. We also debrief with the client about their experience at the IME and obtain their own statement.
Second, we obtain the IME report as soon as possible. Time is of the essence. By seeing the IME physician’s exact claims, our attorneys know exactly what needs to be refuted to the insurer. Riemer Hess will demand a copy of the report from the insurer on our client’s behalf.
Third, we will then comb through the IME report to uncover inaccuracies, contradictions, and omissions. For instance, it is not unusual for an insurer to provide incomplete or even faulty information to the IME physician. They may not have included our client’s most recent medical records or testing results that reflect their symptoms. Without this vital evidence, the IME physician consequently will conclude our client is not disabled.
Fourth, the IME report must be rebutted. The best person to write the rebuttal is our client’s own treating doctor. Because their treating doctor has an established history with our client and familiarity with their medical history, their opinion is more valuable than an IME physician who only met our client once for a brief time. We work with our client’s treating doctor to make certain their rebuttal addresses all of the IME physician’s unsupportive statements. It is important for the rebuttal to make as airtight an argument as possible for our client’s disability.
The treating doctor’s rebuttal is then submitted to the insurer, along with any other new medical evidence that has been obtained since the IME.
IMEs are a tactic frequently used by insurers to deny or terminate disability benefits for their claimants. If your insurer has scheduled you for an IME, you may want to speak to an experienced long term disability attorney.
At Riemer Hess, our New York ERISA attorneys are highly familiar with how insurers weaponize IMEs against claimants. We understand the best strategies to avoid or cancel an IME, and how to mitigate common problems that arise before, during, and after undergoing an IME.
The attorneys and staff at Riemer Hess know how to navigate IMEs and keep your disability benefits secure. Contact an attorney at Riemer Hess today at (212) 297-0700 or click the button below to schedule a call with one of our professionals to discuss your long term disability claim.