How to Protect Your Interests During an Independent Medical Evaluation for Long-Term Disability Insurance

Independent Medical Evaluation

If your long-term disability insurance company requests that you attend an “independent medical evaluation” (IME), it has probably already made up its mind to deny your claim and is in search of a physician to confirm its conclusion. An insurance company will want to shore up its decision to terminate your claim with “objective” medical evidence. But an IME is neither “independent” nor “medical.” Fortunately, there are some steps you can take to protect your interests and preserve fairness in an unfair process.

Why IMEs are not objective

Independent medical evaluations (also known as independent medical examinations) are far from independent. Many financially distressed physicians with failing practices have a strong incentive to make a finding of “not disabled” in order to save insurance companies money and preserve their own lucrative consulting arrangements. These physicians are not neutral. They are paid hitmen on a mission to find every medical excuse to find that you are not disabled. Often, they will attend IME seminars that will teach them how to write IME reports that favor the insurance company and find claimants not disabled. 

Why IMEs are not medical

A good medical doctor will take you at your word. If you say you have a pain in your neck, he or she will evaluate you for that pain and suggest treatment options along with further tests and imaging studies. An IME physician is under no such obligation. Indeed, in the majority of states, an evaluee and an IME physician do not have a doctor-patient relationship. The IME physician is financially incentivized to not believe your subjective complaints of pain. If you tell an IME physician that you have a severe pain in your neck, he or she will search for records to support his or her own spurious conclusion that you do not have a pain in your neck and that you are faking. 

Further, a real medical doctor will actually review your records. An IME physician will have his staff or insurance company staff review your records and type a biased summary of the records. Sometimes the IME physician will review the summary and, sometimes, he or she will not.

IME physicians are not above outright lies

Don’t be surprised if your IME physician outright lies in his report. In one case handled by our firm, the IME physician opined that, even though the claimant had all the indications of a severe hand disability, she was faking. He stated this conclusion was based on the video surveillance, which he had personally reviewed, and which showed the claimant was able to walk her large and unruly dog on a leash. The only problem was that our client was allergic to dogs, did not own a dog and had brown hair, while the woman in the surveillance video was blonde and clearly outweighed our client. Despite this, the IME physician stood by his evaluation.

What to do if you are sent for an IME

There are very few ways to avoid an IME. Every long-term disability insurance contract requires that you submit to a physical evaluation upon request by the insurance company. There are, however, some steps that you can take to preserve fairness in the IME process.


Record, videotape or bring a third party to the IME

Let the insurance company know, in writing, that you wish to tape or videotape the evaluation. If the insurance company refuses to accommodate this request, advise it that you will bring a third-party neutral to the evaluation with you. That third party should write down the time you arrived and left the IME; his or her impressions of the physical building in which the IME is located (many physicians do not conduct IMEs in their offices. Rather, they rent space in run-down, low-budget suites); the physician’s questions, your responses and the tests that the physician performed. Often, IME physicians will abbreviate their evaluations when they are backed up with appointments in their rented, low-budget, examination suites. Just as often, their written reports will reflect that they observed your heel-to-toe walk or tested your patellar reflexes when no such tests were performed. It is invaluable to have contemporaneous notes and the potential testimony of a neutral observer to confront or rebut the IME physician’s findings.


Know your medical history and bring your records

The IME physician will ask you about your medical history. This is most likely because he or she did not yet or will not read your medical records. You should know your medical history. Be ready to provide the IME physician with the names of your physicians, dates procedures were performed, dates and results of imaging studies and medications you are on. Do not exaggerate your medical history or your symptoms. Be ready with simple, forthright, and factual answers. Physicians, even bad ones, can detect an exaggerator.

Google your IME physician

Prior to your IME, research the physician who is to evaluate you. Is the IME physician licensed in your state? Has the IME physician been plagued by malpractice suits? Does that physician have a reputation for finding people “not disabled?” Find out if courts have questioned his testimony or reports. If you find out your physician is a frequent flyer on the “not disabled” list, write a hyperbole-free letter to the insurance company and request a different IME physician, documenting your bases for this request with specific references.

Know that they are watching you

There is a 50% chance that the insurance company will hire a private detective to follow you to and from your IME appointment. It is cost-effective for the insurance company to engage in hidden surveillance at this time because it knows when you are going to leave your home and where you are going. Be mindful that insurance companies may film you a few days prior and a few days after your IME appointment, as well.

And the surveillance doesn’t end at the doorsteps of the IME physician’s rented examination suite. Often, the physicians themselves will watch you walk from the parking lot to the waiting room. They will watch if you “fidget” or “don’t fidget” in your chair in the waiting room. They will ask you to get on to the exam room table to observe the ease with which you rise from your chair to the table. They will watch you as you leave their office and get into your car. IME physicians will include their observations of you in the parking lot and in their exam room in their final report. 

Send a letter to preserve documents

Subsequent to your IME, send a certified letter, return receipt requested, to the physician who conducted your IME and demand that she or he preserve all communications with the insurance company, or with the third-party company hired by the insurance company to preserve all records. Specifically, this request should include a request to preserve all emails, faxes, medical records, draft reports and handwritten notes.

Often, the reports written by physicians are altered by the insurance company or the vendor hired by the insurance company to suit the insurance company’s needs. It is smart to preserve all of the evidence as best you can.

If you have questions about your long-term disability insurance claim or your independent medical evaluation, or you are involved in a dispute with your insurance company, contact the long-term disability insurance attorneys at Schwartz, Conroy & Hack. We have the expertise and tenacity to make sure insurance companies keep their promises to policyholders like you.