Why does your insurer want an independent medical exam?

Your disability insurance company certainly wouldn’t take a determination of your disability from a doctor you’ve never actually met in person – but that’s essentially exactly what happens when your claim is denied. The insurance company’s doctor, a person you’ve never met, makes the decision that you’re not disabled (and not entitled to benefits) based solely on the paperwork in your claim file.

That usually starts the battle between the medical experts and you and your long-term disability (LTD) insurer. To try to resolve the issue, you may be asked to go to an independent medical examination (IME). This is usually a brief, in-person exam with a doctor who has been hired to give a third opinion on your condtion and limitations.

Aren’t IME doctors basically hired guns for the insurance company?

Not every doctor who does IMEs is biased against disability applicants, but many are. You can generally get a feel for whether a doctor is likely to be biased by checking into their practice. If they have a pretty robust private practice and only do evaluations as-needed, they may be indeed be fairly neutral.

On the other hand, if a doctor only sees patients for IMEs and makes their living that way, you can bet that they don’t want to be seen as too “sympathetic” toward those they evaluate. The referrals front he insurance company would likely dry up pretty quickly.

How do you tilt the odds in your favor that an IME will help your case?

You don’t want to walk into an IME expecting a very extensive evaluation, so you need to have as much information ready to hand the doctor as possible. Make copies of all your own medical records and take them with you to the appointment. Give them to the IME doctor so that they are obliged to consider them when writing their report.

You may also want to take someone with you to the evaluation. While your friend or family member should remain quiet during your examination, their presence alone can prompt a more careful evaluation process. Plus, they can be called upon later to testify about what did or did not happen during the exam.

If you’re struggling to get your long-term disability approved, find out more about the legal assistance that’s available.