A part of the long-term disability insurance claims process is to submit to an Independent Medical Evaluation (IME). Although you have been diagnosed with a disability by your doctor(s), the insurance company will want to obtain an “independent” evaluation of their own. But the doctors that are performing this “independent” evaluation are paid by the insurance company and have an interest in keeping them happy by giving you an unfavorable exam. In this article, we dive into the process and how you can prepare yourself for your IME.
8 Things To Know Before Your IME:
1. It is common for the insurance company to call you and ask that you have an independent medical evaluation. While they have you on the phone, they will probably ask you if it’s okay to do an in-depth phone interview. The purpose of this phone interview is to interrogate you about your disability. The facts and comments that you say will be recorded and used against you if you are inconsistent with your answers. What you say in the phone interview needs to match what you tell your doctor as well. They will review what you say to the doctor about your symptoms and pain levels. If what you say to the doctor does not match what you say to the insurance company, this will allow them to say you are untruthful.
You will most likely be under surveillance during the time between the phone interview and your appointment with the independent medical evaluator. For this reason, it is important to not push the boundaries of your restrictions by doing something you shouldn’t be doing. For example: If you have told the insurance company that you cannot stand, lift, or pull heavy objects, it is probably not a good time to cut the grass. Do not volunteer any extra information. Simply respond and stop.
2. Once you are given the date and time of your IME appointment, call your primary care doctor, and request an appointment for the same day. This should be the doctor that has been providing your care during your disability. This appointment is important for two reasons. First, it shows that you had a physical with your doctor the same day as your IME. Second, sometimes the IME examiner can be a little harsh when they are examining you, which can leave you swollen and in pain. The exam performed by your doctor can help document this by including these symptoms in your notes. This documentation can be extremely important in showing arbitrary and opinionated reports by the IME examiner.
3. Review your medical history and previous illnesses before your IME. An easy way for the examiner to “catch” you in a lie is when they ask about your medical history, and you get your facts confused. Although it is common not to remember every lab result and surgery date (especially if you’ve had multiple surgeries). The IME examiner will use your confusion to claim your case is fraudulent. By studying your medical records, you will be more at ease when asked to recite your medical history. Items to focus on are chronological medical history, a statement of the nature and extent of your disability, the last day you worked and how your disability affects your daily life (dressing/undressing, eating and preparing meals, using the bathroom, moving around from one place to another); the list of limitations and restrictions your doctors have given you; and your treatment plan that was discussed with your previous doctor.
An experienced IME examiner will take every opportunity to trap you if you omit information or get your dates confused.
4. Send a certified letter with return receipt requested notice to the disability insurer requesting that they provide you with the following information:
What percentage of the IME examiner’s practice is dedicated to diagnosing and treating patients who are disabled from the same condition you now have?
How long has the IME examiner been working for the insurance company? What percentage of the reports provided by the IME examiner is in favor of the insurance company?
Request a copy of the curriculum vitae of the IME examiner. A curriculum vitae is an overview of a person’s work throughout their life. It includes qualifications, publications, and any academic work they have produced.
Request copies of any published articles the IME examiner has written on your diagnosis in particular.
Ask them to describe in writing the basis for choosing this particular examiner to conduct the IME. Look up the IME examiner on the internet. This is an important question to have answered, especially when you are asked to travel a long distance to have your exam, passing by other providers that could perform the same exam.
You have the right to request a copy of the IME report to be sent to you and your primary doctor. This request needs to be sent by certified return receipt requested. Otherwise, the insurance company can stay they never received your request. It is also important to request that any mental health or nervous condition reports are sent to you directly and not your doctor’s office.
5. If the insurance company gives you an appointment date that doesn’t give you or your attorney enough time to research the credentials of the IME examiner, request a continuance.
6. Never attend your IME exam alone. Bring a friend or family member with you to support you, ask questions, and take notes for you. Take someone with you that is assertive and looking out for your best interest. This type of person is more likely to protect you if the examiner gets too rough or starts to harass you. Having an extra person with you in case you need to take a break when you are exhausted will help you.
On the day of your examination, be aware that you will probably be under surveillance. Do not do anything during the day that your doctor has restricted you from doing. If you have been ordered to use a cane, use your cane or if you are required to wear a back brace, make sure you wear a back brace. It will be a good idea to bring a camera and take photos of your body if you are swollen afterward. The IME examiners have been known to say that the person is not swollen after the exam. However, photos can prove they are untruthful.
7. The IME examiner will try to trick you during the exam. They will touch places on your body that are not connected to any nerve, joint, or muscle and ask you if that hurts. If you say yes, they will assume that you are being untruthful and label your claim as false. One test is called Waddell’s Signs. There are five components to Waddell’s.
Tenderness – The examiner will touch or lightly pinch you over different parts of your body that are commonly known not to cause pain. If you say it’s tender or sensitive, they will think you exaggerate your symptoms. If you claim to have pain in areas that are not localized to the area of the injury, they will also say you are exaggerating your symptoms. Some illnesses like fibromyalgia affect the entire body, but if you express that you have pain all over your body, the examiner will be suspicious of your reactions.
Simulation tests – Simulation tests are used to test for a broad range of things. But they can also be a trap. For example, if the examiner pushes down on the top of your head and you say that it hurts your lower back, they will say you are exaggerating. If the examiner may also test your range of motion by asking you to stand and then twisting your upper torso; if you say that it hurts your lower back, they will say you are exaggerating.
Distraction tests – If the IME examiner does find something wrong with you, he/she may try to distract you by performing another test without explaining that to you. If you do not give the reaction they are looking for, they will be suspicious.
Regional Disturbances – Complaining about pain, muscle weakness, numbness, or tingling in an area that is outside of the range of nerves, the examiner may claim you are exaggerating.
Overreaction – If you cringe, contort, or scream in pain, the examiner will see this as an overreaction to the exam and say you are exaggerating your symptoms.
8. Remember that the examiner is not there to give you medical advice. They are there to prove to the insurance company how severe your disability is and will try to disprove you by putting you through these grueling exams. Try to stick to yes or no responses to the examiner’s questions. Although you want to believe that this medical professional would be there to look at you objectively, they are paid by the insurance company so do your best not to volunteer any information that can be used against you.
Consult with a Disability Attorney
An independent medical evaluation is far from “independent.” Since the insurance company pays for the IME examiner, they often have a more favorable opinion for the insurance company. Using these eight steps, you can prepare yourself and protect yourself during an IME.
Using an experienced disability attorney will help you protect yourself against insurance investigators. The Nick Ortiz Law Firm is based in Florida but represents claimants across the country. Receive a free consultation by calling (888) 321-8131 with no obligation. We will fight to get you the Long-Term Disability Benefits you deserve.
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