When you’re receiving long-term disability insurance benefits through your insurance company, you should know that you might have to take an IME exam. This exam can have a large impact on how much you receive for disability benefits from your insurance provider, so you should have a good idea of what you can expect and how you should handle each step of the process. These are some best practices that you should incorporate into the process that you undergo.
What Is an IME?
IME stands for Independent Medical Exam, and it’s a test that your insurance provider of long-term disability insurance might ask for you to take after you’ve been diagnosed with a condition. Your insurance provider might ask you to take this test because you’ve been receiving benefits for a while and they want to see if you still meet the qualifications. Otherwise, they might ask you to take this exam because they’re uncertain of whether or not you received the correct diagnosis in the first place.
One of the most important things that you should know is that the doctor that your insurance provider is likely to send you to is paid by your insurance provider, so they might not be entirely unbiased, and this can negatively impact the number of benefits that you receive from your insurance provider. You should also be aware of the steps that you should take to maximize the likelihood of having a favorable outcome.
Involving an Attorney
An extremely important step to the IME process is for you to get an experienced attorney to ensure that all of the steps are taken correctly. It might seem strange or even unbelievable, but even if your insurance company has all of your medical records and they say that they’re going to pass it along to the doctor doing the IME, that doesn’t always happen. And if the doctor doing the exam doesn’t have all of your medical information, it isn’t realistic to assume that they’re going to be able to make a proper diagnosis. An attorney can ensure that the doctor receives all of your medical records.
Additionally, some people don’t realize that they have a right to videotape the entire exam to ensure that it’s done properly and thoroughly. When you get an experienced attorney, we can ensure that this right is enforced. Finally, an experienced attorney can point out any factual mistakes or allegations to ensure that you’re not taken advantage of. They’ll then direct you to the right ways to fix this so that you don’t have further problems down the road.
Malingering
Malingering is a behavior in which a person fakes or exaggerates their symptoms in order to avoid work, and you should definitely not do this when making a claim. Your aim should be to win the claim based on your honest and serious symptoms. Malingering is a form of deception even if you don’t explicitly tell a lie. Malingering can be in the form of exaggerating your symptoms by the way that you act, walk, or talk. But people can find even more elaborate ways of malingering, including doing things to chemically alter their urine or do other things to throw off test results. You should never try these ideas because it’s very possible to get caught, at which point your credibility will be gone.
If you feel like someone from the insurance company or the IME doctor is in a roundabout way accusing you of exaggerating or making things up, it’s very possible that they think that you might be malingering. You shouldn’t feel bad about this, though. It’s a biased opinion, and it’s often motivated by a desire to avoid paying out insurance claims. Your only job is to make sure that you’re being as truthful as possible so that you can win your claim based on honest facts rather than deceit.
Being Truthful
Whenever you’re applying for benefits or defending the ones that you have already been awarded, you should always be truthful. You want to be honest with all of the claims that you make both for your own feelings of integrity but also because you could get caught being untruthful.
When you go in for an IME test, you should assume that you’re being watched before and after the exam. When you go into the doctor’s office, you’re going to be under surveillance, so if you drastically change the way that you walk to do any other kind of activity when you enter the building, it’s very likely that someone will notice.
Additionally, it’s common for insurance providers to even hire someone to follow you to determine whether or not you’re being truthful. If they find that you’re exaggerating a limp when you go into the doctor’s office but walk relatively normal when you’re out at the grocery store, there’s a good chance that you’ll be denied your claim.
You should also aim to tell the whole truth. For instance, if you have a pain that comes and goes, you need to report it as such. If you only say that the pain in your leg is so difficult to bear that you can’t get out of bed and are later seen walking around on certain days, this will be seen as fraud even if you occasionally have times when you’re unable to get out of bed.
Other Tips
Another strategy that you can employ is to bring in a trustworthy witness into your doctor appointment. This type of witness will usually be someone who is either a trusted family member or friend. That way, if the doctor tries to make false claims, you’ll have someone else there who can corroborate your version of events. You should ask your witness to take notes. For instance, you’ll want your witness to note the time that the appointment starts and when it ends. You should also have your witness write down statements that the doctor makes about your condition or abilities. You should also have your witness write down what kinds of activities the doctor asked you to do and what kinds of discomfort, pain, or difficulties you report to the doctor at the office. Finally, your witness should also write down anything that they found unusual about how the visit went.
You should also assume that you’re under surveillance both before and after you have your visit with the doctor. It’s even common for insurance companies to hire private detectives to follow you before and after your appointment in an effort to catch you malingering.
Also, make sure that you make strong relationships with the doctors that you regularly see. The IME isn’t the only piece of evidence that a court will look at if you have to appeal, so you shouldn’t feel like this is the only way that you can show that you really have the condition that you say that you have. Instead, you should build those relationships with your other doctors so that they’re there for you to corroborate their findings when your claim is questioned.
How We Can Help
There are several ways in which the team at Osterhout Berger Disability Law can help you receive the benefit you deserve. We help individuals who need to…
- Apply for Social Security Benefits and want to ensure everything is done right the first time
- Appeal a denial of Social Security Disability Benefits
- Appeal an existing denial of Long Term Disability (LTD) Benefits
If you are facing one of these situations, please do not hesitate in reaching out. Our team of experienced attorneys are here to help, and your consultation is free.
