Every Short Term Disability or Long Term Disability benefits insurance policy reviewed by the author has a provision allowing the insurance company an opportunity to conduct its own “independent” medical examination of the claimant, commonly referred to as an “IME.” There are any numbers of reasons an insurance company might avail itself of its rights under this provision of the Long Term Disability insurance policy.
Why Are Independent Medical Examinations Conducted for Disability Claims?
One reason is a legitimate concern in the face of complicated or somewhat conflicting medical evidence. This is one of the opportunities the insurance company has to get an actual eyeball on the claimant. Unfortunately, this may be the reason for the IME in another way. When an IME is scheduled, the insurance company will know the route from the claimant’s home to the site of the examination. Many times, this is used as a time to conduct surveillance on the claimant. More eyeballs.
There are many considerations that need to be considered when the insurance company indicates it going to set an IME. First, the site of the
examination must be reasonable in terms of distance. Second, it must be determined that the examiner is properly qualified to examine the disabling medical conditions. We have had occasions where the examiner was not so qualified but the insurance company wanted to go ahead anyway. In a spirit of cooperation, we did so but with a well-worded statement about the examination being of no relevance.
Another consideration is documentation. The IME report will not be made available unless there is a denial of benefits. As I tell my clients from the beginning of my representation, it is necessary for the client to maintain a diary and take notes on their claim, just like everyone else involved in the claim is doing. The diary is a good place to write any questions which come regarding the case, whether for me or for your doctor. It is also a good place to prepare for the IME. You should get your questions ready although the doctor may rightly not feel compelled to answer them. This is because he or she was hired to perform a specific examination and answer the questions the insurance company has for them. The IME doctor may ask you if you have any questions and it would be good if you were prepared.
Do You Have An Independent Medical Examination Scheduled? We Can Represent You
If an IME is scheduled in your Short Term Disability or Long Term Disability claim, please give Herbert M. Hill, P.A. a call and we would be glad to answer any questions you may have. Please call 407-839-0005 or, toll free, 844-454-5995, After reviewing your claim, we can set up a free office or zoom conference, whichever works best for you.
Herbert M. Hill, P.A. is a law firm located in Orlando, Florida with a practice extending throughout the southeastern United States. While the vast majority of cases handled are for disability insurance benefits, areas of practice include employee benefit claims of all sorts. The firm handles any claims arising under the Employee Retirement Income Security Act (“ERISA”) for disability benefits, medical benefits, retirement benefits of any sort, including pension, 401k, termination agreements or the like as well as claims arising under private disability policies.
