What is an IME?
Most disability insurance policies have a provision that can force you to undergo an “independent medical examination”. Because the examination is performed by someone chosen by the insurance company, there is nothing “independent” about it at all. These Insurance Medical Examinations (IME) are intended to gauge your medical, cognitive, or psychiatric condition(s). Your insurance company chooses the physician through a third-party vendor and pays that third-party vendor for the exam. The vendor pays the physician for their time and opinion.
Understanding this process is key: you need to know how IMEs work to ensure that you remain eligible for the disability benefits to which you are entitled.
Overview of the IME
Once the insurance company has found a physician, the vendor will call you to schedule an in-person examination. The doctor will typically review your treatment records provided by your insurance company before the exam. The IME itself will usually last about one hour and is made up of an interview and physical examination. The interview portion will likely focus on your medical history and treatment. The physical examination may include various testing measures like grip strength and range of motion testing.
After the interview and physical examination, the physician will prepare a report that addresses questions posed by your insurance company. While those questions can vary based on the nature and extent of your medical conditions, the insurance company ultimately wants the examining doctor to decide if you are prevented from performing your job duties.
How to Prepare
1. Travel – know where the IME will be held and figure out how you will get there. If the exam is scheduled far from your home, make sure you talk to your disability insurance company and let them know the problems it presents for you.
2. Medical records – read your medical records before your interview to get a feel for what the doctor will have and ask you questions about. If you have a copy of your records, bring them with you to ensure that the examining doctor has all of the necessary information to properly evaluate you.
3. Context – the fundamental question is: why can’t you work? Be prepared to answer that question fully.
The Examination
1. Be truthful and honest about your disabling conditions. If you exaggerate your symptoms, the examining doctor will include that in their report. The insurance company will then use that as a basis to deny your claim.
2. The doctor will observe your behavior throughout the interview and examination. It is important to communicate if you are experiencing any symptoms that limit you or cause you discomfort.
3. Be careful! This is not your doctor. Whatever you say will likely be shared with your insurance company. You need to cooperate with the doctor and avoid being combative. Avoid downplaying your symptoms or otherwise indicating that you are fit to work.
4. Be vigilant. The doctor’s conduct is just as important as yours. Make a note if the doctor does or says anything that seems out of the ordinary to you. Some examples from our previous clients’ IMEs include 5 minute examinations, doctors who told the client to pray to make the pain go away, doctors with a sloppy appearance and open pants, doctors who refused to let the client’s spouse wait in the waiting room, doctors whose offices had no staff or other patients, and even doctors who made implicit threats to the client. Sometimes, these circumstances are grounds for invalidating the results of the IME.
After the IME
Make sure you get a copy of the IME report so that you can share it with your treating physician. If the report is unfavorable, it is a near certainty that your insurance company will adopt the opinions eagerly as grounds to deny your claim. If that happens, we can help challenge the doctor’s opinion. This can include reviewing the doctor’s education, training, and experience. It can include pointing out incorrectly summarized facts in your medical records. It can also include noting that the doctor focuses on irrelevant details while downplaying evidence that supports your disability. All of these issues need to be assessed before filing a lawsuit.
If your insurance company has scheduled you to undergo an IME, you should contact us immediately to help.