When you file a claim for long-term disability benefits in Houston, it’s not uncommon for an employer, insurance company or legal counsel to request that you submit to an Independent Medical Examination (IME). However, in many cases, these examinations are anything but “independent.”
In order to collect long-term disability benefits, you must establish that your disability is so severe that you are unable to return to work. Even though your personal physician has performed a thorough examination and documented your disability, the insurance company will usually want a second opinion before making their final decision about your claim. That’s the purpose of the IME — to provide the insurance company with a second opinion that either confirms or disputes the diagnosis arrived at by the first physician.
What Is an IME?
An IME is a medical or psychiatric evaluation to determine the current status of your medical condition and/or determine whether the condition is related to employment.The IME process usually involves a short physical examination performed by a doctor who is selected and paid by the insurance company. Unlike your regular doctor, the physician conducting the IME will not recommend or provide any medical treatment. There is also no legal doctor/patient relationship, so nothing said between you and the physician is considered to be confidential. Following the examination, the physician will submit a report and provide an opinion on your condition.
How “Independent” Is an Independent Medical Examination?
The fact that the same parties requesting the IME also choose the doctor who will make the examination — and pay for their services — often raises concerns as to how “independent” these examinations really are. Many of these doctors have been selected because they can be relied upon by the insurance company to provide a diagnosis that will be favorable to their interests — regardless of the patient’s actual condition.
So, can you refuse to undergo an IME? No — not if you want to collect disability benefits. Most disability policies contain language that specifically states that benefits may be denied or suspended if you fail to submit to an IME.
While you may not be able to avoid the IME, there are things you can do to protect your rights.
- Don’t get caught off guard — be prepared to answer any questions about your condition.
- Be honest — don’t exaggerate your symptoms.
- Insist on having a witness present during the exam.
- Record the exam using a cellphone.
- Ask to review all paperwork and other documents sent to the physician by the insurance company.
- Ask to receive a copy of the physician’s report.
Get a disability lawyer involved in the process, especially if your claim is denied because of the IME. An attorney will know how to obtain and assemble all the necessary documentation that supports your claim and make certain it is received by the examining physician. They will carefully review the IME physician’s report to challenge and correct any factual errors that may have been included. If your claim is denied, your attorney will prepare an appeal that addresses the factors that led to your claim being rejected.
Don’t Let an IME Sink Your Long-term Disability Claim
The results of an IME can have a huge impact in a long-term disability benefits case. If you feel that an independent medical examination has been used to limit or terminate your disability benefits, you should seek the services of an experienced disability denial attorney without delay.
M. Stanley Whitehead is a leading board-certified Houston disability benefits attorney. He has extensive experience in successfully assisting clients with long-term disability claims. We may not be able to prevent you from having to undergo an IME, but we will fight to protect your rights and ensure you get as fair and impartial an examination as possible. Contact us to schedule a free consultation meeting to discuss your long-term disability case.