Your private disability insurer may require you to undergo what is known as an “independent medical examination” (“IME”). Indeed, most disability insurance policies include provisions that permit the insurer to require claimants to undergo an examination with a physician of its choosing. Whether you receive disability benefits can depend largely on what the physician conducting the IME concludes regarding your medical, cognitive, or psychiatric condition(s). Therefore, it is crucial that you understand the details and workings of the IME to be sure that you receive the disability benefits to which you are entitled.
Independent Medical Examination Guide: How to Prepare for an IME
In order to prepare for an IME you must understand how it works. Although IMEs are deemed independent, that can sometimes be far from the case. In theory, it is an objective assessment of your disabling medical conditions. The examination is independent in the sense that the doctor conducting the examination is not directly employed by your disability insurer. However, the insurer selects the physician through a third-party vendor. The insurer will also pay the third-party vendor for the exam, who in turn pays the physician for his or her time and opinion. In practice, disability insurers typically request an IME to combat your doctor’s opinion supporting your inability to work.
The IME process itself is straightforward. Once the disability insurer has found a physician, the third-party vendor will schedule you for an in-person examination near your home. The doctor will typically review your treatment records provided by your disability insurer prior to the examination. Then comes the IME – the examination itself will usually last about one hour and consists of an interview and physical examination. The interview portion will likely focus on your medical history and treatment; and the physical examination may include various testing measures such as grip strength and range of motion testing.
Following the interview and physical examination, the physician will prepare a report that addresses questions posed by your disability insurer. While those questions can vary based on the nature and extent of your medical conditions, the insurer ultimately wants the examining doctor to determine your functionality and whether you are prevented from performing your job duties.
With that process in mind, it is important that you prepare for the IME beforehand. Although it is likely second nature to you, be familiar with your medical history, treatment, prescription medications, and test results, if any. Be ready to articulate to the examining physician why exactly you are unable to work. In other words, does pain, fatigue, weakness, decreased range of motion, or other symptoms prevent you from working? Furthermore, arrange for any necessary accommodations. That includes transportation if you are unable to sit or drive for extended periods.
How Do I Pass an Independent Medical Examination?
While IMEs do not produce strictly “pass or fail” results, there are certain steps you can take to be sure that the examination findings accurately reflect your disability and resulting limitations.
First and foremost, be truthful and forthcoming regarding your disabling impairments throughout the examination. If you embellish or over-exaggerate your symptoms, the examining doctor will include that in his or her subsequent report; and your insurer will rely on that to justify its denial or termination of your disability benefits. Likewise, the doctor will observe your behavior throughout the interview and examination. Therefore, it is important to communicate whether you are experiencing any symptoms that might limit you or cause you discomfort.
What Should You Not Say in an Independent Medical Examination?
An IME differs from a stereotypical doctor visit in several ways. First, there is no patient-physician relationship with an IME. Therefore, the IME is not confidential or privileged and everything discussed throughout the examination can be included in the examining doctor’s report. Similarly, the examining doctor does not treat the examinee.
Given the unique nature of an IME, it is likely that the examining doctor will document your cooperation, or lack thereof, during the examination. Therefore, you must cooperate with the examining physician and avoid presenting as confrontational or combative. Outside of that, avoid downplaying your symptoms or otherwise indicating that you are fit to work.
The examining physician’s conduct can be just as important as yours. Make a note if the doctor does or says anything that seems out of the ordinary to you. It may be grounds for invalidating the results of the IME all together.
What Happens When the IME Doctor Disagrees With My Doctor(s)?
If the examining doctor finds that you do not require any medical restrictions or are able to work through your impairments, then the insurer will certainly adopt that opinion to justify denying or terminating your disability claim. However, that is not the end of the road – you or your disability benefits attorney can still challenge the doctor’s opinion. Your disability insurer is often required to provide you with the examining doctor’s report and allow you an opportunity to respond.
There are multiple issues to look out for when challenging an IME report. First, the insurer may have requested an IME from a doctor who lacks proper experience related to your medical conditions. The physician also could have incorrectly summarized factual findings in your treatment records. The largest issue that arises within this context is the examining doctor’s focus on irrelevant findings while simultaneously downplaying the severity of findings or opinions that support your disability. You will need to point that out to successfully rebut the examining doctor’s opinion.
If your insurer has scheduled you to undergo an IME and/or the examining doctor disagrees with your own doctor(s), you should seek the assistance of a disability benefits attorney who specializes in representing individuals to help them keep or receive their disability benefits.