The Independent Medical Examination, or “IME,” may be requested by a disability insurance company to provide an unbiased, professional medical opinion from an outside specialist who has no prior relationship with the patient. Should the medical examiner determine you are not disabled, your benefits could be denied. On the other hand, if the medical examiner agrees with your attending physician and confirms what you’ve known all along, you will likely experience no trouble getting your claim approved.
What happens during an independent medical examination?
Family physicians, chiropractors, physical therapists, psychiatrists, psychologists, and other specialists can all qualify as independent medical examiners. Should you accept the proposition, you will be asked to sign consent forms and fill out a medical questionnaire. You should bring to your appointment a written list of your current medications, physicians, symptoms, important dates, activities, and restrictions. If you have diagnostic image reports, be sure they are forwarded over. Depending on your case, you may be examined physically or psychologically.
Be honest and courteous during the exam. If you are pursuing a legal case, do not discuss the details without a lawyer present. You can bring a friend or family member with you to the exam, but this person will likely not be allowed in the room with you. If you have not initiated a lawsuit against the insurer, then you will not be allowed to record the session. On the other hand, if you have initiated litigation, there may be circumstances where a defence medical examination may be recorded upon request from your long term disability lawyer. It is your right to obtain a summary of the independent medical exam afterward.
Are independent medical examinations fair to disability applicants?
If you’ve been asked to go for an independent medical exam, you may wonder about your rights in this situation. After all, not every medical professional will arrive at the same conclusion regarding your condition and ability to work. Will the IME jeopardize the amount of disability awarded?
Independent medical assessments must be reasonable, but they can become an area of concern if the insurance company is trying to minimize or deny your disability benefits. The main caveat is that the disability insurer will be the one paying for the exam, which can pose a conflict of interest.
Naturally, the insurer is hoping to get an IME that supports their position. Not surprisingly, insurance companies tend to use the same doctors over and over again, and exercise some influence over how the final report turns out.
Consulting with a personal injury lawyer can answer some of your questions and ensure you are given a fair opportunity to pursue disability benefits coverage.
Can you refuse the independent medical exam?
It is your right to refuse the IME, but there is also a risk in refusing to be seen by the insurance company’s third party medical examiners. The insurer is likely to view this decision as non-cooperation, which could suspend or terminate your right to disability benefits. If you have a specific reason to refuse the assessment, provide the insurer with an explanation, and they may agree to arrange an assessment with a different provider in their network.
What if you disagree with the examiner’s assessment?
You can ask your family doctor to refer you to a specialist in the same field as the insurance company’s expert to “get a second opinion.” The combined support of your family doctor and a specialist who agrees with your doctor’s findings can increase your odds of winning against the insurance company and their chosen medical examiner. You also have the right to appeal the insurer’s decision.
If you have received a letter requesting that you submit to an independent medical exam, contact a disability law firm to discuss your rights. It costs nothing for this consultation. Preszler Law, a trusted long term disability law firm based in Vancouver, has successfully represented a number of British Columbians who have had their long-term disability benefits denied or terminated as a result of an insurance company IME.