Independent Medical Examinations in Long Term Disability Claims
Every Short Term Disability or Long Term Disability insurance policy reviewed by our firm includes a provision allowing the insurance company to conduct its own independent medical examination of the claimant. These examinations are a common part of the claims process and can significantly impact your eligibility for benefits.
Why Are Independent Medical Examinations Conducted?
Insurance companies schedule Independent Medical Examinations (IMEs) for several reasons. In some cases, they may have legitimate questions about complex or conflicting medical evidence. The IME allows the insurer to obtain an additional opinion from a physician of their choosing.
However, IMEs can also serve another purpose: observation. When an IME is scheduled, the insurance company knows when and where you will travel. It is not unusual for insurers to conduct surveillance during this time to monitor your behavior and daily activities. Understanding these possibilities can help you prepare.
Location: The examination site must be a reasonable distance from your home.
Examiner Qualifications: The doctor conducting the IME must be qualified to evaluate your specific disabling conditions. Some insurers have attempted to schedule examinations with physicians who are not properly credentialed for the relevant medical issues.
Documentation: Keep a personal record of all IME-related communication. The IME report is typically not shared unless the insurer issues a claim denial, so maintaining your own notes is essential.
How to Prepare for an IME
Clients are encouraged to maintain a diary throughout the duration of their claim. This diary should include:
Notes on symptoms, treatment, and medical visits
Questions to discuss with your doctor or attorney
Observations from the IME experience itself
You may bring your notes to the IME, although the physician may not answer personal questions. Their role is to perform a specific examination and address the insurer’s inquiries. Being prepared, however, helps ensure accuracy and accountability.
The Role of an Attorney During an IME
The IME process is often intimidating, particularly when your financial stability depends on the outcome. Having an attorney who understands disability insurance law and the tactics used by insurance companies can make a significant difference.
At Herbert M. Hill, P.A., we represent claimants throughout Florida in Short and Long Term Disability claims and denials, including those governed by ERISA. Our legal team reviews the IME notice, confirms the legitimacy of the examiner, and advises clients on what to expect before, during, and after the examination.
Do You Have an Independent Medical Examination Scheduled?
If your insurance company has scheduled an IME in connection with your Short Term Disability or Long Term Disability claim, we encourage you to seek legal guidance before proceeding. The IME can directly affect your eligibility for benefits, and it is important to be prepared.
Herbert M. Hill, P.A. is a disability-focused law firm located in Orlando, Florida, with clients throughout the southeastern United States. Our practice is primarily dedicated to disability insurance and employee benefit claims, including:
Long Term Disability and Short Term Disability benefits
Claims governed by the Employee Retirement Income Security Act (ERISA)
Private disability insurance disputes
Retirement and severance benefit claims
Contact an Experienced Disability Insurance Attorney
Before attending an IME, protect your rights and ensure your claim is properly managed. Contact us today to schedule a consultation. We can review your claim, answer your questions, and provide experienced representation to help you pursue the benefits you deserve.
