What Is an Independent Medical Examination?
An independent medical examination (IME) is an exam performed by a medical professional not currently associated with your case. However, we don’t like using the term “independent” when referring to a medical examination ordered by a disability insurance company. The word independent is in quotes because we do not believe these physicians are really independent. We prefer to call them “compulsory medical exams.” They are meant to be impartial, but some insurance companies hire the same doctors repeatedly because they usually write reports in favor of the insurance company.
Do I Have to Attend an IME?
It depends on what your policy says. Your duties and obligations are outlined in the insurance policy. If it says you must attend an exam upon request, then you must do so. You may even be asked to attend multiple IMEs. If it does not have such a provision, you may not have a contractual obligation to attend the exam. However, I can tell you that most policies have such a provision.
Thus, you should carefully review your insurance policy. If your contract has a clause that says you must “cooperate” with the insurance company in its investigation into your claim, and you fail to “cooperate” by not going, you may be denied benefits for your refusal to attend an IME.
What Happens During an IME?
In almost every case, our clients tell a similar story about how the IME was conducted. The examination is usually a cursory affair—the physician conducts a minimal interview and takes a short history from the claimant. This is followed by a quick “once over” check of the claimant’s medical condition, and then the IME is over.
Remember that the examiner is not there to give you medical advice. The doctor will not administer any medical treatment and does not want to find any problems; in fact, they want to make sure not to find any evidence of your disabling condition. 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.
Be Wary of IME Doctor Tricks
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:
- Tenderness—The examiner will touch or lightly pinch you over different parts of your body that are commonly known not to cause pain. They will think you exaggerate your symptoms if you say it’s tender or sensitive. If you claim pain in areas 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. The examiner may also test your range of motion by asking you to stand and then twisting your upper torso; if you say it hurts your lower back, they will say you are exaggerating.
- Distraction tests—If the IME examiner finds something wrong with you, he/she may try to distract you by performing another test without explaining that to you. They will be suspicious if you do not give the reaction they are looking for.
- Regional Disturbances—If you complain about pain, muscle weakness, numbness, or tingling in an area outside 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.
After the examination, expect the IME examiner to watch you walk back to the parking lot (or claim that they did so) to try and find evidence of malingering. If the examiner was too rough with you and you are sore and swollen, it would be a good idea to take photos of your body if you get swollen afterward. If the examiner tries to say that you were not swollen after the exam, photos can help prove they are untruthful.
Tips for Your Independent Medical Exam
Be Careful Talking to the Insurance Company
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 doing an in-depth phone interview is okay. The purpose of this phone interview is to interrogate you about your disability. Do not volunteer any extra information, just answer the questions.
What you say in the phone interview should also match what you tell the IME doctor. 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, they will say you are untruthful.
Request a Copy of the Report In Advance
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 via certified mail with a return receipt requested. Otherwise, the insurance company can say that they never received your request.
Watch Out for Private Investigators
Your activities also need to align with your responses during the phone interview. You will most likely be under surveillance between the phone interview and your IME. The investigator will be waiting outside your home to watch and record your every move during these times. Highlights from these recordings will be provided to the evaluating doctor, who will then make additional blanket statements, such as stating that your activities “were in excess of your stated abilities.”
For this reason, it is important not to 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. 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. Remember that all your activities will be taped and held against you during these times.
Schedule an Appointment with Your Doctor
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 who 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 on the same day as your IME.
Second, sometimes, the IME examiner can be a little harsh when examining you, which can leave you swollen and in pain. Your doctor’s exam 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.
Review Your Medical History
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.
Remember, the Doctor Is Not on Your Side
Insurance companies often employ the same doctors repeatedly to conduct medical examinations. These doctors derive a significant portion of their income from these assessments and are incentivized to produce reports that favor the insurer’s position. They are familiar with disability insurance terminology and use it strategically to align with the insurers’ interests and secure ongoing engagements.
During the examination, limit your responses to the doctor’s questions to simple ‘yes’ or ‘no’ answers. 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. You may see this in your own IME report.
When reviewing the doctor’s final report, be alert for language that could undermine your credibility, such as “excessive complaints,” “symptom exaggeration,” “secondary gain,” and “malingering.” Such terms indicate an intent to cast doubt on your credibility, which might be used to challenge the findings of your treating physicians more easily than disputing the facts.
The objectivity of an independent medical examination report varies based on the examiner. It’s not uncommon for these doctors to disregard their professional training and make overarching statements aimed at denying your claim. They are aware of their role and the expectations set by their employers. If you believe that the insurance company has chosen the particular doctor performing your examination because they believe the doctor is “fair,” then you are being naïve.
Consider Requesting a Continuance
If the insurance company gives you an appointment date that doesn’t give you or your attorney enough time to research the IME examiner’s credentials or find someone to attend the exam with you, consider requesting a continuance.
Never Go Alone
Never attend your IME exam alone. Bring a friend or family member to support you, ask questions, and take notes. Take someone with you who 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.
Types of IMEs and How to Prepare
Neuropsychological Tests
Of all the IME types, the neuropsychological exam is the most overused. It uses scientific tests to measure brain functions, including simple motor function, problem-solving, and reasoning skills. Then, the results are compared to “normal” test results. The most important thing to remember is that this test measures the brain’s present level of functioning.
The most common neuro-psych tests exam the following:
- Attention and processing speed
- Motor performance
- Sensory acuity
- Working memory
- Learning and memory
- Abstract thinking
- Mood & temperament
- Intelligence
- Language
- Calculation
- Vision analysis
- Problem-solving
- Judgment
- Executive functions
A neuropsychological evaluation helps detect suspicious activity. The assessment also looks for bias and malingering (exaggeration or fabrication.) A well-known test for malingering is the MMPI-2 (Minnesota Multiphasic Personality Inventory), and it is requested by insurance companies often. Other common exams are the Beck Depression or Anxiety Scales, which measure depression and anxiety levels, and The Bender Visual Motor Gestalt test, which looks for signs of brain dysfunction, emotional problems, and brain development maturity. A test for patients with suspected dementia is the Dementia Rating Scale, which assesses the claimant’s overall brain functioning and memory levels. Likewise, the Halstead Category test measures overall brain function for claimants not suspected of dementia.
Of course, many more tests can be used based on claimants’ history and suspected disability. These exams are usually interpreted by in-house (insurance company) neurologists and psychologists. It is common for these professionals to lean toward the insurance company’s side since they are the ones paying them. These tests can be very subjective and rely heavily on the evaluator to interpret the results. Although testing can be appropriate for some disabilities, using neuropsychological testing alone to examine disorders like depression and anxiety is not appropriate.
The raw testing data used for the analysis should stay with the psychologist and never be included in your disability file. Only the report of the findings should be in your disability file. Insurance companies have been known to put the raw data in claimants’ files and have an unqualified person, such as a registered nurse or primary physician, make assumptions based on the raw data. If you find out from the insurance company that someone other than a psychologist is making recommendations based on your data, that is a red flag and should be reported to your attorney.
Functional Capacity Examinations
Although functional capacity examinations are a significant part of the disability claim process, they do not always benefit the insurance company. This is because the examiner is a trained occupational therapist when dealing with a physical injury like bones, feet, hands, and back. They usually provide very objective, accurate, and verifiable results. However, this does not make the insurance companies happy. They prefer more subjective testing that can be swayed in their favor.
Functional capacity tests measure how much weight you can lift and carry, your range of motion, like reaching and bending, and fine motor skills, like grasping a pencil or pinching small items to pick them up. Depending on your line of work, you may also be tested on your ability to crawl or climb stairs. There are four rating options: sedentary, light, medium, and heavy-duty. You will be assigned a list of restrictions or limitations that you cannot do or that you can do that follows the rating options. The IME examiner will also note if they feel you are giving your full effort.
Psychiatric and Psychological Tests
The purpose of psychological testing is to give you a rating on the AXIS scale and GAF scale. The GAF is a global assessment of functional rating. The GAF scale measures how well you handle social, emotional, and occupational problems. It has been around since the 1960s, and in 2013, it was dropped by the manual of psychiatrists and replaced with a rating scale developed by the World Health Organization, but insurance companies still use it and will probably not change anytime soon.
Here is the GAF Rating Scale:
The average person scores between 60 and 80 on this scale. A score below 60 can indicate a problem. The IME examiner uses the rating scale to interpret what is considered normal.
Claimants can also have an Axis diagnosis. The Axis Scale has four levels:
- Axis I – Clinical Primary Diagnosis
- Axis II – Personality Definition
- Axis III – Physiological: any organic problems that may be present
- Axis IV– Social: Loss of a loved one, sexual abuse, divorce, career changes, etc
Again, the insurance company interprets these results, but they usually favor the claimant. This can be good for you.
What To Do After Your IME
- Get a Copy of the Report Before Discussing It: If your claims adjuster calls you to discuss your IME, don’t discuss it until you have a copy of your report and time to review it.
- Point Out Inaccuracies: Don’t be afraid to point out inaccurate information in the report. Use data from your medical file to support claims.
- Question the Doctor’s Relationship with the Insurer: Request in writing the following from your disability adjustor:
- How many referrals has the doctor received from the insurance company in the last five years?
- How much compensation does the doctor receive per IME?
- Is the doctor who evaluated you a specialist in your disability?
- Have Your Doctor Review the IME: If the IME report is unfavorable, request that your doctor review it and note the inaccuracies. Your treating doctor’s opinion may outweigh the IME doctor’s.
What If My Long-Term Disability Claim Is Denied After an IME?
If you are denied long-term disability benefits, and the insurance company cites your IME as the determining factor, this is not the end of your case. You need to consult a disability attorney who will obtain statements from your treating physicians disputing the IME report and can use advanced appeal strategies like hiring medical or vocational experts to support your claim.
Nick Ortiz, an experienced long-term disability attorney and founder of the Ortiz Law Firm, can help you through every step of the process, from initial application to potential appeals. He will only get paid if you win your case. You can seek help without worrying about upfront costs or unexpected bills. Our legal team focuses on your case so you can focus on your illness.
We have successfully represented long-term disability claimants across the United States. We offer a free case evaluation with no obligation to use our firm if your claim has been wrongfully denied or terminated. We will review your denial letter and answer any questions you have. If you want to speak with an experienced long-term disability attorney, please contact us online or call (888) 321-8131.
