JustHealth

Webmaster's Note: This is an extremely important article, and you might want to use the Print button at right to print it out and study it, since it's also long.  It may be worth the study; your IME can determine whether your claim is paid or not. 

Your Independent Medical Evaluation

(Employers and disability insurers may disagree with me concerning the motives, philosophy and objectives of being asked to submit to an IME. I will graciously concede that not all policyholders or insurance companies operate in the same manner; however, I think all would agree disability insurers probably are not paying between $2,500-$6,000 for a medical evaluation to "continue to pay" a disability claim. There is always a vested interest on the part of an insurance company to obtain credible documentation for the purpose of supporting a claimant's  ability to perform work at some level.)

            Whenever you place your mental or physical impairment at issue with the expectation of receiving disability compensation, the disability insurer (or other responsible party i.e. worker's compensation, social security) has a right to have a physician of its own choice examine you. Although the procedural rules governing IME's vary among  state jurisdictions, several general requirements are universal. Some disability policies have contractual provisions requiring you to submit to an IME, "as often as is reasonable", or " when the claim is pending", others do not.

            The disability insurer must give you reasonable notice of the time, place, and name of the IME examiner as well as the scope of the evaluation. You have the right to be reimbursed for mileage to and from the place of the evaluation, and the insurer must reimburse the examining physician for the evaluation report. The IME physician is required to provide a copy of the report to you, or, your attorney within a reasonable time after the examination. However, if you claim is being investigated by the insurance company, it is not required to provide you with a copy unless your claim has been denied.

            In exchange, you are required to provide copies of all medical office treatment notes, lab reports, consultations etc. from each physician who has examined or treated you for the impairment you are now claiming. In addition, most disability companies will also ask you for a signed authorization so that other information may be obtained before your IME date. I realize this may seem as though your privacy is being invaded, but patient/doctor privilege with respect to the condition causing you to stop working is generally considered to be waived at the time you make application for disability compensation.

            `The IME physician may be subpoenaed to give testimony under oath during a deposition, and may be cross-examined at trial if your claim is litigated at a later date. Therefore, it is extremely important to be prepared for the IME and understand the objectives of the examiner.