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Episode 4 Independent medical exams requested by disability insurance companies can be dangerous


Episode 4/1: IME Exam Requested By Disability Insurance Companies Can Be Dangerous
Episode 4/2: IME Exams Requested By Disability Insurance Companies Can Be Dangerous

Disability insurance companies will often rely on either an Independent Medical Exam (IME) or an External Medical File review without examination in order to deny a long term disability claim. I never consider a an IME exam to be independent because you are required pursuant to the terms of your disability policy to appear at the exam and the allegedly independent exam is being paid for by the insurance company.

You should not think that your claim will be automatically be denied because an IME exam has been requested; however you must be prepared to adequately handle your IME Exam and all of the event both before and after the IME exam.

Unlike an IME exam in which a disability claimant is actually examined by a doctor, the insurance companies will often hire outside doctors to review your file and renders opinions about your physical abilities without ever examining the claimant. This process is known as external medical file review without examination.

In this episode disability insurance attorneys Gregory Dell, Stephen Jessup and Cesar Gavidia of Attorneys Dell & Schaefer discuss IME exams, the biases of many disability insurance companies that request these exams, and the “whore” doctors that regularly find that claimants are not disabled. In an effort to further educate disability claimants about IME exams and External File Reviews we will answer the following questions:

  1. Do I have to attend an IME exam requested by my disability insurance company?
  2. Why is my disability insurance company requesting an IME exam?
  3. Will my disability insurance company give me a copy of the IME report?
  4. Can my disability claim be denied if my disability company never conducted an IME exam?
  5. Are independent medical examiners hired by a disability insurance company truly independent?
  6. Are the outside companies hired by disability insurance companies to locate IME doctors independent?
  7. What can I do to protect myself during an IME exam requested by my disability insurance company?

If you had an experience with a disability insurance or an IME doctor, please post a comment so that the thousands of people that visit our website each month can learn from your experiences. The sharing of information can help stop the unreasonable claims handling practices of many disability insurance companies.

Please note: Disability insurance attorney Gregory Michael Dell created Disability Insurance Law TV in order to educate long term disability claimants about common issues related to long term disability insurance claims. New episodes are filmed on regular basis. Our disability videos are for informational purposes only and they are not legal advice.

There are 4 opinions so far. Add your comment now.

T. L. Smith:

I recently had to go have an IME exam done for Aetna disability which was required by them, that I go to their doctor, right when my long term disability policy was changing from my own occupation to any occupation. They refused to let me have a licensed RN nurse of my choice in the room for the examination and they also refused to let me video tape or record the exam. After a 30 minute exam, the IME doctor put in his file that I could do full time sedantary work.

Interestingly, I have had 3 specialists including two pain management doctors and a neurologist state that I was only capable of working no more than 10 hours a week of sedantary work. When I called Aetna to get an update, as I only had one month left before a decision had to be made, my anylist told me that they found I was capable of working full time sedantary work. When I asked how they can justify their doctor who is paid for by them, contradict 3 specialists and my primary care doctor, who had just done a new update the month before, I was told that medical conditions can heal.

I was told they sent information to my own doctor to dispute and if she didn’t dispute it, that my disability would be terminated May 31st 2011.

When I went to see my doctor on May 3rd 2011, she told me that Aetna sent her video tape that was taken of me without my knowledge or permission, which I hear is pretty common, however it is illegal for them to send video to a third party which then makes it used for public and or commercial use, without my written consent. Of course the video was edited to show me in a bad light and in favour of the insurance company. My doctor, stood her ground and said there was nothing in the video that indicates anything about me being able to work full time sedantary work. Once the video goes public to any third party, it falls under the privacy rights of an individual. The insurance companies, know it is illegal but they continue to do this practice to intimidate doctors and try to get them to change their evaluations and also to intimidate the claimant into dropping their case.

Attorney Greg Dell:

T.L., your experience with the IME exam requested by Aetna is the same protocol that we have seen with other Aetna claimants around the country. I have discussed Aetna’s IME tactics in other articles on this site. You should request copies of the IME report be sent to your treating physician and then have your treating physician send back a written response. It is important that your physician writes a very detailed response that takes into consideration your restrictions and limitations. If you need assistance with an Aetna Appeal, contact us for a free consultation.

Suzie:

Hi, I have Cigna LTD group insurance and right after I was approved 11/2015 I was in a bad auto accident 12/2015 I was very fortunate to only have minor injuries but oh boy did it exasperate all my chronic pain including fibromyalgia with high chance of PTSD that has caused so much miserable Pain, depression/anxiety and even worse brain function. It’s all been very slowly getting better. I told Cigna early on about the wreck and that it just exasperated pain. She asked if I received any money which I haven’t because I was already in pain and suffering and at fault driver just had $25,000 PIP with multiple cars/people involved. It turned out the accident also caused dislocated discs in joints of both jaws with fluid in left one, but I had TMJ prior so, I was hoping it would calm down some but I still have to eat soft foods, hurts to talk sometimes and they locked a few times and also tortures my neck problems and tension headaches.

Cigna has requested an IME and I’m afraid to call too much attention to the wreck and both my PM doctor and I feel this has probably caused permanent disability or at least wasted a year of possible rehabilitation and maybe another year before I’m even back to the way I was when I went out on disability.

1. Have you known there to be any limitations/restrictions on continuing to pay a claimant having this type of personal injuries while receiving benefits?

2. I’m terrified of this IME. The PTSD and high pain levels has ruined communication skills most of the time and memory is extremely poor (I sound much better when able to edit and take a very long time, like now) I’m not fit to handle a verbal examination. What can I do?

Thank you so much for your time

Attorney Stephen Jessup:

Suzie, it is not uncommon for disability to result from an accident. In a situation like yours if there is an open/or resolved personal injury claim Cigna may have the right under the policy to reduce your benefit by the amount received from any settlement. This would be largely based on the language in your policy. Your policy almost certainly creates a duty to attend an IME. Your failure to do so could result in your claim being denied. If you have additional questions please feel free to contact our office to discuss your claim further.

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