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Do I have to cooperate during a neuropsychological IME Exam requested by the disability insurance company?

Disability insurance companies are notorious for requesting Independent Medical Exams (IME or CME) in an effort to try to deny disability benefits. Our disability insurance lawyers have helped thousands of claimants to prepare for these obviously unfair and often biased examinations. Unfortunately disability claimants are required to attend an IME exam and cooperate while being examined. Let’s take a look at a recent ERISA disability denial lawsuit in which a claimant a neuropsychological IME exam but failed to cooperate with the examiner.

Claimant Denied Disability Benefits After 12 Years Due to Failure to Cooperate

A Federal Appellate Court recently upheld the termination of disability pension benefits under an ERISA governed plan for a claimant who had been on claim for 12 years due in part to her failure to cooperate during a Plan ordered Independent Medical Examination (IME). In finding that the Plan did not abuse its discretion in denying benefits, the Court noted that the Plan conditioned continued eligibility for disability benefits on “compliance with recommended treatment” and “cooperation during evaluations requested pursuant to the Plan.” During the course of the claim, one of the claimant’s treating doctors noted that she was no longer in compliance with recommended treatment, which in turn raised a red flag and prompted an evaluation of her claim by the Plan.

In evaluating the claimants continued eligibility for disability benefits, the Plan informed the claimant that she must attend an IME to include neuropsychological testing. Following initial refusal by the claimant, she finally underwent the testing. The results of the testing indicated that she put forth inadequate effort, exaggerated her symptoms, and possibly malingered. Based upon what was deemed her failure to put forth adequate effort and “cooperation during evaluations requested pursuant to the Plan” her benefits were denied. The claimant appealed the denial twice, filed a lawsuit and lost, and then appealed the initial court decision to the Appellate Court.

Appellate Court Agrees With Lower Court And Upholds Disability Denial

During appellate review, the Court noted that the claimant was granted the opportunity to submit additional documents to explain her test performance, and that the information provided on appeal failed to show she was incapable of participating in the IME. The Court, in rendering its decision, even points to the fact that the Claimant had been able to adequately perform the requested testing less than two years earlier.

The Court ultimately made the following findings:

It was not unreasonable for the Plan to require attendance at two IME exams in an 18 month span;
It was not unreasonable of the Plan to require her to attend the neuropsychological IME; and
The claimant’s failure to comply with treatment and to cooperate during the IME evaluation were reasonable grounds for termination of benefits.

Lessons Learned From This Recent Disability Denial Lawsuit

This recent case serves as a reminder that it is extremely important that a claimant comply with all provisions of a Plan. We have previously discussed the importance of attending required Independent Medical Examinations, and that the failure to do so could result in the denial of benefits. This case takes this discussion and evaluation one step further by holding that attendance alone is not enough, that adequate effort and cooperation must be given during an IME. However, it must be noted that the ERISA governed Plan at issue in this case specifically stated “cooperation during evaluations requested pursuant to the Plan.” Each Plan (or Policy) can be written with different language, so it is important to know and understand your duties under your particular Plan. This case also serves as a reminder that disability benefits, be it from a disability pension plan or disability insurance policy, are not guaranteed benefits and that entitlement to benefits will be continually reviewed on a month to month basis. Lastly, this claimant could avoided this entire situation if she had complied with her treating physicians treatment plan and had supporting documentation from her treating physician.

For more information on Independent Medical Examinations please see “What should I expect when I attend an IME exam requested by my disability insurance company” and “Do I have to attend an IME requested by my disability insurance company?“. If your insurance company is requesting you submit to an IME or you have questions regarding your claim for benefits please contact Attorneys Dell and Schaefer for a free consultation.

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Reply

Sent on July 5th 2024 by Attorney Gregory Dell

David:

It’s horrible that Hartford did that to you.

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Reviews from Our Clients

S.S.

I am a physician in my 30s who was practicing in my hospital based medical specialty until my Multiple Sclerosis diagnosis began to severely limit my physical ability to work.

My husband and I were obviously in distress at these very unwanted life changes and frankly overwhelmed with the possibility of a long and traumatizing legal battle ahead of us. We knew we were legally entitled to benefits through the separate private individual and employer based ERISA disability insurance policies we had, but even cursory research and discussion with colleagues made it clear that insurance companies will strategize with their own legal teams to find ways to not pay out benefits. We found many before us who had fallen unwittingly into legal pitfalls that prevented them from ultimately obtaining benefits. We realized we needed to seek legal counseling.

We found Dell Disability Firm through their youtube channel where their associates have videos discussing the legal intricacies and latest developments in private disability law. I was impressed by their dedication to the field and reached out through their website to request a free consultation.

We were delighted to hear that Mr. Steven Dell himself would be willing to take our case and felt assured that we would be represented by the best of the best.

We have not been disappointed in our expectation and have, in fact, been consistently very impressed. Steven Dell is clearly both knowledgeable and wise about dealing with these issues but more importantly, has shown kindness and impeccable honesty at each step of the way.

Merlin has demonstrated a very high capacity for organizing and handling the endless myriad of documents and communications between us and the insurance companies. She has also been very compassionate, accessible and forthcoming in dealing with our many anxiety fueled emails and telephone calls to her and we are very grateful for her involvement.

For over 7 months, we have been working closely with Steven Dell and Merlin Bryan from Dell Disability Lawyers as they have guided us through the process of review and initial application for benefits from our two insurance policies (Hartford and Ameritas).

We are happy to announce we just received approval of claim from the Hartford insurance company.

At this time we are still working with this firm as we await the final decisions from Ameritas policy that we are hopeful will have a similar outcome.

As anyone with a chronic and progressive illness can tell you, time becomes a very precious commodity. Through their representation, Dell Disability Associates has allowed us to focus the majority of our time enjoying the time and function I have left while resting assured that our disability case laid in competent and caring hands.

The truth is that no amount of money can make up for what we have lost, but it is a huge comfort to have a team like Dell Disability Lawyers at our sides to help us ensure we will be able to continue to care for ourselves and our families.

We highly recommend Dell Disability Lawyers, Mr. Steven Dell and Ms. Merlin Bryan to handle your disability insurance claim.

Thank you Steven, thank you Merlin!

We will certainly plan on leaving another review for completeness once we have our final decision from Ameritas.

Paula B.

I have been working with Dell Disability Lawyers for the past 5 years concerning my disability as it pertained to my employer. I have been more than pleased with them the entire time. They have always kept me informed of any paperwork needing completed or any changes coming ahead. Nothing has been a surprise. I would recommend them to you to help with your disability case if you’re trying to dip into the policy you’ve been paying for.

Michael M.

I am a physician who has been disabled for over 10 years. During this time I have been represented by Cesar Gavidia and his assistant Danielle Lauria. Their representation on my behalf has allowed me to concentrate on dealing with my disability/disease process and all associated complications and not having to deal with all the things that are necessary in a disability claim. Based on my personal experience from many years of practicing medicine I would consider their work product, insight and effort in the disability claim procedures to be superior. I would recommnend them, which I have done, with my highest level of confidence. In short, you well served with this practice.

Dan P.

I had to retire from my career due to a bad back that restricted me from performing my duties. I had LTD insurance and after a few years of receiving monthly benefits from this insurance company, they notified me that my benefits were terminated stating that I don’t qualify due to my duties not fitting into some “national job description” and a nurse had deemed me eligible to go back to work. Its a crushing feeling to have this told to you over the phone with hardly any information given. Luckily, I came across Dell Disability Lawyers and spoke with Attorney Palamara who calmed me down and stated they would take my case. Within a couple of months my benefits were restored, and I had piece of mind. I cannot thank Attorney Palamara and the staff enough at Dell Disability for their professionalism, no nonsense approach, personal and timely communication and quick ability to litigate my case.

Jen S.

I wanted to thank Mr. Symonds and his legal assistant Sonia for their professionalism, guidance and dedication towards my LTD claim. Going through the denial process on my own was going to get me sicker and knew it was time for help right away. I reached out to Dell Disability Lawyers for assistance and not too long after my call, I was connected with Sonia – Soon after that, I was talking about my case with Mr. Symonds. After a long and tedious process with the LTD insurer, we won the case. The wait can absolutely be lengthy, but in the end, it was all very much worth the fight. Thank you both so much for all that you have done for me! I also want to thank those who assisted in keeping me updated, as needed. Highly recommended for anyone who is going through the brutal process of an LTD denial.

Carl G.

I would like to thank Dell Disability Lawyers for taking care of my case and help me get the insurance coverage that I was rightfully in need of. Specially, I would like to thank Lawyer Alexander Palamara and RIGHT-HAND legal assistant, Sonia Nogueira, who made this process less stressful. They answered all my questions and kept me informed every step of the way.

Don’t get me wrong. They never promised or told me that I was going to win my case, as no one can guarantee that for you. What they did do, was letting me know that they were working hard for me and to keep positive. Something that I recommend everyone to do is to subscribe to their YouTube channel. That will give you an idea on how they operate and why they (for most of their cases) win their cases.

Since I was awarded disability, I am still having surgeries and thanks to Dell Lawyers, I’ve been able to cover all those expenses.

Warm regards to everyone at Dell.

Clarisa B.

I’m so very Grateful and Thankful for the team at Dell. They worked tirelessly to get the best outcome for me. I’m so glad that I found them!!

Carole S.

Exceptional efficient and professional service from Jay Symonds and Sonia Nogueira. They were both so helpful and knowledgeable and navigated me through a very stressful and difficult situation with New York Life.

K. S.

Awesome team. Jay and his team, Sonia and Francesca, truly care. This team is very Professional and quick to respond. Jay always provided answers in detail to my questions. I strongly recommend Jay Symonds.

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