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What Are Independent Medical Exams (IME)?

Male Doctor and Female Patient in Hospital.

If you are trying to obtain short-term or long-term disability benefits from your insurance company, you will likely need to jump through a variety of hoops. All of these requirements are meant to be barriers to your obtaining the disability coverage you paid for. Often, claimants and benefits recipients are asked to attend an independent medical examination (IME). Below, our seasoned Los Angeles disability benefits denial lawyers explain IMEs and how they work in the disability context.

What is an IME?

A disability independent medical examination is a physical examination that a claimant for disability benefits is asked to undergo before an insurance company will provide disability coverage. There are varying requirements for IMEs, typically laid out in the contract. An IME may be required during the initial claim for benefits, or even to continue receiving long-term disability benefits once an applicant has already qualified.

Are IMEs Actually “Independent?”

You may be unsurprised to learn that there are a number of problems with IMEs that render them less than “independent.” First of all, your IME will be conducted by a doctor chosen by your insurance company. In fact, your insurance company is the party paying the doctor to conduct your IME. Unfortunately, this creates a perverse incentive for doctors retained to perform IMEs.

Insurance companies are always looking for reasons to deny, limit, or end disability coverage. That means that they will choose doctors whom they know will serve their interests by looking for reasons to deny coverage. Physicians who always report that claimants are, in fact, unable to work are unlikely to continue to be retained to perform IMEs. Physicians who help insurance companies by scrutinizing claimants and finding any reason to claim they can get back to work, on the other hand, are likely to get repeat business. Shockingly, there are entire medical practices that focus on performing IMEs for insurance companies. It’s a lucrative business, and you can imagine that these doctors are eager to please the parties that pay them.

Can You Refuse to Attend an IME?

Unfortunately, IMEs are often required under the terms of disability insurance policies. No law states that a claimant should be entitled to disability benefits even if they refuse to attend an IME. If you are hoping to refuse your IME, talk to your attorney ahead of time to see if they can find any gap in your policy language or some other loophole that would allow you to skip the exam. In most cases, if you refuse the IME, the insurer can deny your claim or terminate your benefits.

Tips for Making Your IME Fair

If you have to attend an IME, there are steps to take to protect yourself. Firstly, gather all of your medical records ahead of time to ensure that the physician is presented with all relevant evidence. Do not rely on the insurance company to send over your records. If the doctor does not have all of your records, they could have a skewed view of your medical history.

Secondly, you have the right to bring a witness (a friend or family member) to the exam. You may have to keep insisting over the objection of the medical office, but it’s your right to bring a witness with you. Your witness can later attest to the contents and results of the appointment if there is a dispute. Moreover, you can request a copy of the doctor’s report following the exam. If they made any misstatements, omissions, or other mistakes, you can act to correct them before your insurer makes a claim decision.

Trusted Help With a California LTD or STD Disability Insurance Claim

If your disability insurance claim has been unreasonably denied, or if you are dealing with other bad faith insurance issues in California, fight for the coverage you are owed with the help of the seasoned and knowledgeable Los Angeles insurance claim denial lawyers at Gianelli & Morris for a free consultation at 213-489-1600.

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