{3:55 minutes to read} In the world of claims or lawsuits against insurance companies, IME is an acronym for Independent Medical Examination.
These examinations are never truly independent, however. IMEs are requested by insurance companies, and they have the power to hire someone who is more likely to give an outcome that’s favorable to them. That is who they typically hire.
Especially in the context of long-term disability claims, the insurance companies themselves no longer call these examinations “independent.” Instead, they often use the acronym EME, which stands for Evaluative Medical Examination.
How Are IMEs Governed?
Generally speaking, rights relating to an IME are governed by the policy. A policy has certain provisions for the purposes of determining the scope your, the insured’s, obligation in connection with an IME. These provisions include:
•The actual rights of the insurance company to have a medical examination or a functional capacity evaluation, or a psychological or psychiatric examination;
•Proof of claim or proof of loss;
•Cooperation requirements; and
•The area of exclusions and termination rights contained in the policy.
These are the general provisions to look to in order to see the scope of your obligations as claimant, and the insurance company’s rights concerning an IME.
How Do I Prepare for an IME?
In terms of getting ready for an IME, there are certain things that are very, very important to do before the examination begins:
1. If you have an own-occupation policy, you must ensure that the doctor performing the evaluation or examination knows your job duties, including the physical and mental demands of your job.
For example, if you were a dentist, doctor, trial lawyer or securities professional, ensure that the doctor evaluating you doesn’t treat the situation like a Social Security Disability claim, but instead understands that you had specific occupational duties. The doctor should be determining if you are limited in or prevented from performing those duties.
2. Make sure that the doctor has all of your relevant medical records.
Many times, those medical records will be supportive of you and contain a history of deterioration regarding your condition—perhaps even objective evaluations and tests which demonstrate the condition exists and supports your complaints of pain or your limitations. Also, make sure that the doctor chosen is appropriate for purposes of determining the reason you’re disabled. For example, you don’t want an internist evaluating an orthopedic condition.
3. Check the doctor out.
Insurance companies tend to hire people that will be good for them, but not for you. Often, the doctors are biased, have had past problems or all they’ve ever done is insurance company evaluations, and have never found a claim they wanted to approve. A qualified lawyer can do various legal searches, internet searches and share information with other colleagues, checking on the evaluator’s background and status, to help you know what you are getting into.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack
800-745-1755
ESS@schwartzlawpc.com