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Why is my disability insurance company requesting an IME exam?



When an insurance company sends this notice to the claimant and says – we want to do an independent medical exam, what are they really looking for? Why are they asking for this exam?

Well, realistically what they are going to be looking for, in my opinion, is some way to try to justify the denial of a claim. It may have been that they have reviews of medical records, they have one of their internal reviewers look at it, they have questions about maybe have him go through an IME just to document it. Or it is a way to kind of counter what your own doctors are saying. So IMEs can be a lot of times set up when they are initially going to try to initially approve the claim for benefits, or as the case may serve as a ground in the near future to try to determine the benefits.

When these IME exams are requested, is it the same format for every single exam the doctor is supposed to look for or do insurance companies ask the doctors to look for specific things?

You’ll see sometimes especially in a lot of the ERISA appeals, once you get the claim file, you’ll see where they will have a questionnaire sent to the independent reviewer or doctor and say – this is exactly what we want you to look at, we want you to compare it to the job that they are saying, this is where we want you to focus. Other times it may be more of a general overall exam, in other cases it maybe a functional capacity evaluation.

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