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Episode 16 10 things to expect when your disability insurance company asks for an IME exam



Almost all disability insurance policies provide a disability insurance company with the right to have the insured examined by a physician of their choice. The disability insurance companies can select any physician and a claimant must attend.

These exams are commonly referred to as Independent Medical Exams (“IME EXAM”); however many courts refer to them as Compulsory Medical Exams (“CME EXAM”) since the claimant’s benefits will be denied if they fail to appear.

Disability Insurance Attorneys Gregory Dell and Stephen Jessup discuss what a claimant should expect if asked to attend a CME exam. It’s always best to get an attorney involved if your disability insurance company has requested a CME. Here are some the question that Attorneys Dell and Jessup will discuss in this video:

  1. Is the disability claimant required to attend the CME exam?
  2. How should a disability insurance claimant act at a CME exam?
  3. Are the CME doctors the enemy?
  4. Are the disability insurance companies videotaping the disability claimant at anytime before, during or after the CME exam?
  5. Should a claimant videotape, audiotape or bring an independent witness to the CME exam?
  6. Should a claimant complete paperwork that is presented at the actual CME exam?
  7. Is the CME exam suppose to be a deposition of the claimant?
  8. Does a disability claimant need to complain about everything during a CME exam?
  9. How can a disability claimant get a copy of the CME report completed by the physician following the exam?

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 14 opinions so far. Add your comment below.

Pam Anderson:

Thanks for the above video but wish I had seen it before I had my IME appt. As always I am too trusting & should have checked this out before I went to the IME dr. Now I have been turned down by Liberty Mutual due to the IME physician’s report & all my benefits have stopped. I am 59 female have had 3 major back surgeries include 2 were fusion last one 3/9/10. I have been on ltd with them since 6/11/10. Now I am without income & no way I can work in my condition. I have already filed for social security disability but that is still pending & could take another year.

Attorney Greg Dell:

Pam,

In order for us to determine if we can help you we would need to review the denial letter that Liberty Mutual sent you. You only have 180 days to appeal the disability denial so it is important that you take action quickly. Once we receive your denial letter and a copy of your Liberty Mutual Policy we will be able to let you know immediately if we can assist you.

Wayne:

I, like the other claimants, have been through the grinder with Reliance Standard. I was approved for SSDI @ 2 years after filing with the advocator group and went for a IME at Reliance Standard’s request. 30 days later I was denied benefits. I have not received my denial letter yet but loosing my income will be devastating and I will loose my house. Can you suggest what I can do?

Attorney Stephen Jessup:

Wayne,

If your policy is governed by ERISA, you will be required to file an administrative appeal prior to being able to file a lawsuit. Please contact our office to discuss how we can possibly assist you in appealing the denial of your claim.

Mrs. May:

Your video is very informative; however I had no choice but to complete a book of forms at my IME.

I have a claim with Reliance Standard. My LTD benefits have been in effect for almost 5 years and I was given notice by Reliance, in writing, over two years ago that my benefits would continue until I reached age 67 as they realized I would not be able to go back to work on any consistent basis. However, I still had to comply with annual medical reviews which had gone smoothly, as my condition has not improved, until this year.

Then this fall after sending in my annual medical records Reliance then notified me that they were sending my records for a independent “review”. I followed up a month later and was then told I would be hearing from the Dr. to schedule my exam. Surprise, you’re being required to go to an IME.

So I recently went to an IME ordered by Reliance Standard. I took someone with me who video taped the entire visit. However, based on the video I watched before the IME, I did initially refuse to fill out the paperwork requested by the IME when I arrived. I was told that if I did not complete the paperwork the appointment would be cancelled and I would be considered to have been in non-compliance with the ordered IME.

So being backed into a corner I had no choice but to fill out the paperwork. What other choice does a person have and believe me they, the IME office and your disability carrier, know that.

All this after having in writing my benefits would continue to age 67. Apparently nothing they put in writing is worth the ink it’s written with.

There really should be some true legal recourse. My annual review has now been going on for 3 months and I still have no answer about my benefits. Would be nice if the courts realized that the loss of these benefits can mean the difference between having a roof over your head vs. living in your car.

Attorney Stephen Jessup:

Mrs. May,

Is Reliance Standard still issuing your benefit? Unfortunately, the letter you received advising benefits will continue to the maximum benefit period (age 67 in your case) is more a notice as to the potential benefit period and usually contains some type of language that indicates “should you remain disabled under the terms and conditions of the policy.” Disability benefits are never guaranteed and a review for continued benefits could be as frequent as monthly. If Reliance Standard does look to deny your claim please feel free to contact our office to discuss how we may be able to assist you.

Michele:

Was sent for an IME by Liberty Mutual after being on Workers Comp. for 5 years. I drove 45 minute to see their doctor. I didn’t have to fill out any paperwork and I was in with him for about 5 minutes. He asked me about 20 questions and then had me bend right, left, back and forth. And that was it. I have now been denied benefits. I have never in 5 years stopped treatment or changed treatment. What can I do?

Attorney Stephen Jessup:

Michele,

Was the IME for a long term disability insurance claim or a Worker’s Compensation claim? If it is for the former you will have to complete the administrative appeal process – please feel free to contact our office to discuss same. If it is the latter you will need to consult with a Worker’s Compensation attorney – we can also assist you in trying to find one in your area.

M:

I was put off from work ar the end of May 2014. In July 2014 I applied for SSD all at same time of receiving Short Term. In Dec 2014 I received letter from Social security that I was eligible for benefits. My short term ended and LTD was started. I got check for the first 6 months. Then it was time for a review and it was denied, I did an appeal and now they are sending me for 2 different Rehmatology appointments one is 2hrs the other is almost 4 hours away. My major dx is SLE Lupus, Sjogrens, Raynauds, Osteo Arthritis, Fibro, Anixery, Depression, Hx of herniated and buldging disc. My question is why two different docs??

Attorney Stephen Jessup:

M,

Typically an insurance company will only send you to one doctor for a particular specialty. Who is your carrier? Please feel free to contact our office to discuss your appeal and claim further.

C.:

I am receiving benefits from my LTD company currently and have been for over 18 mths. I just received a letter stating I need to go to an IME. My workmans Comp claim is still pending thru a different insurance company. Do I get a lawyer now because of their request or wait to see if I get denied for further benefits?

Victor Pena:

C: You should contact one of our attorneys to discuss your options.

KATIE:

Is it legal for the disability insurance company to send you for an IME, which is set up through a third party vendor, with paperwork stating the disabled individual will not receive a copy of the report provided by the doctor? Also, is it legal for the disability insurance company to share medical information with the third party vendor when the vendor is not a registered health care provider but just a paper pusher?

Attorney Alex Palamara:

Katie, unfortunately, yes it is legal for the disability insurance company to send you to an IME. They use 3rd part vendors to make it seem that there is no conflict of interest in the hiring of the doctor who will perform the IME. Also, under the ERISA laws, the insurance company does not have to provide you with documentation from your claim file until the render a denial of your claim. Also, the authorization you signed for the insurance company likely allowed them to share your info with 3rd party vendors. Regarding the paper pusher, I would need more information. -Alex

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