What to Do If Your Disability Insurance Company Requests an IME

If you’re receiving long-term disability (LTD) benefits and your insurance company suddenly schedules you for an Independent Medical Exam (IME), it’s important to understand what’s at stake. An IME is not truly “independent”; it’s a medical evaluation arranged and paid for by your insurer, often with the goal of reassessing your eligibility for benefits. While the exam may be presented as routine, it can be used to justify reducing or terminating your payments.

This is why working with a knowledgeable Philadelphia disability insurance lawyer and preparing properly for the exam can make a significant difference in protecting your rights and continuing your benefits.

Why Insurers Request IMEs

A disability insurer evaluation through an IME is typically used to reassess your eligibility for benefits. This could happen shortly after your claim is approved or at regular intervals throughout your LTD claim. Insurance companies use these evaluations to determine whether your medical condition has improved or if there is any inconsistency between your reported symptoms and medical evidence.

Despite the term “independent,” the doctor performing the IME is hired by the insurer and may have a financial interest in providing reports that favor claim denials. That’s why it’s crucial to treat the IME as a significant step in your disability claim process.

How to Prepare for an IME

Preparing for an IME is more than just showing up on time. The exam is often brief, and the IME doctor may base their entire report on a short interaction. Here’s how you can safeguard your claim:

• Understand the scope of the IME: Your insurer must inform you of the type of doctor you’ll see and the general reason for the exam. If you’re being sent to a specialist unrelated to your disabling condition, this could be a red flag.
• Review your medical records: Familiarize yourself with your documented symptoms, treatment plan, and physical limitations. This will help ensure consistency during the IME.
• Be honest but concise: Answer all questions truthfully, but avoid exaggerating or volunteering unnecessary details. Let your medical records speak for your long-term history.
• Bring a witness if allowed: Having someone accompany you can help document the exam’s duration and what was said.

What to Expect During the Exam

An independent medical exam for LTD claims usually includes a physical exam, a review of your medical history, and questions about your daily activities. The doctor may try to identify any inconsistencies or evidence suggesting you can return to work.

After the IME, the doctor will issue a report to your insurer. Unfortunately, many claimants report that IME doctors gloss over medical details or fail to consider their own treating physicians’ opinions. This is why it’s important to take steps in advance to ensure your side of the story is properly documented.

Tips to Protect Your Disability Benefits

You can take proactive steps before and after your IME to strengthen your LTD claim.

Before the exam:

• Talk to your own doctor: Let them know about the IME and ask them to document your ongoing limitations.
• Keep a journal: Write down your symptoms and daily limitations leading up to the IME.

After the exam:

• Write a summary: Record your own version of what occurred during the IME, including how long it lasted and what tests were done.
• Request a copy of the IME report: You have the right to review the findings that may affect your benefits.

Need Help with your IME? Call Edelstein Martin & Nelson

If your insurance company is requiring a disability insurer evaluation, it’s a sign they may be preparing to reduce or terminate your benefits. Don’t wait until a denial arrives. Consulting a lawyer who understands disability claims can help you prepare for the IME, identify unfair practices, and submit additional evidence to counter a biased report.

Our skilled Philadelphia disability insurance lawyer can provide the strategic guidance you need at this critical stage in your claim. At Edelstein Martin & Nelson, we’ve helped countless claimants navigate the IME process and fight for the benefits they deserve. Contact us today at (215) 731-9900 for a complimentary consultation and safeguard your future.