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IME Q & A

The insurance company called me to attend an IME in about a week. What should I do?

Inform the insurance company in writing you are unavailable on that date and need to have at least a 30 day notice.

Is video taping the IME a good idea?

Generally, no. The existence of a known videotape is discoverable. This means it could be required to be produced to a defense attorney if the claim goes to court. Video tapes or CD's are a "two edged sword" in that they can be used in your favor, or, they can be used against you. I don't know too many claimants who are so well-versed on the system, insurance laws, and ERISA that they know exactly what they should say, or not say, at any given moment. Video tapes can be used in your favor, but if you do or say something wrong, the insurance company will be sure to use it against you. Do you want to take that chance?

What do I do if the IME physician is rough and hurts me during the examination?

Tell the physician right away that you are in pain and terminate the evaluation. If you are severely hurt, ask the IME physician to call an ambulance.

Am I allowed to take breaks during the exam?

If the evaluation is lasting more than 30 minutes you are entitled to take a break whenever you need to.

Am I entitled to a copy of the IME report?

No. You are entitled to a copy of the IME report as part of your Administrative Record only if your claim is subsequently denied under the ERISA statues. On occasion, the disability insurer will voluntarily give it to you to "help you understand why your claim has been denied." You can ask for it, but don't insist you are entitled to it. You are not.

Types of Independent Medical Evaluations

The Neuropsychological Tests

            One of the most over-used IME's is the Neuropsychological Evaluation Test. A Neuropsyche exam uses scientifically validated tests to evaluate brain functions, cognitive abilities, and depression from simple motor performance to complex reasoning, cognition, and the ability to solve problems. The results of these tests are then compared with normative standards, which are then interpreted by the physician administering the tests. While CT scans, MRI's, EEG's and PET scans identify structural, physical, and metabolic conditions of the brain, the neuropsychological examination is the only way to formally assess brain function.

            Neuropsyche tests are performed over a period of 1-2 days with a qualified Neurologist, or Neuropsychologist. The claimant is asked to take a series of tests called the "raw data". (Raw data from neuropsyche tests is prohibited from being transferred to anyone other than those who are qualified to evaluate the results. )

            The tests are scored and the rating is compared to a set of normative standards which are then "interpreted" by the physician doing the evaluation. The test itself is grueling and time consuming. Neuropsyche tests are generally requested by the insurance company when the claimant reports cognitive dysfunction, memory problems, inability to concentrate, and varying degrees of depression. 

Most Neuropsyche tests examine the following:

Attention & processing speed Intelligence
Motor performance Language
Sensory Acuity Calculation
Working memory Vision analysis
Learning & memory Problem solving
Abstract thinking Judgment
Mood & Temperament Executive functions

            A Forensic Neuropsychological Evaluation involves the application of Neuropsyche assessment methods to evaluate criminal or suspected malingering of claimants. Essential parts of this type of exam include tests to identify response bias and malingering. The MMPI-II (Minnesota Multiphasic Personality Inventory) is a well-known test designed to identify malingering, and is often requested by the in-house insurance physicians. Other common tests include the Beck Depression or Anxiety Scales which provide a quick assessment of symptoms related to depression or anxiety; the Bender Visual Motor Gestalt test, evaluates visual-perceptual and visual-motor functioning and possible signs of brain dysfunction, emotional problems, and developmental maturity; and Dementia Rating scale, provides measurement of attention, initiation, construction, conceptualization, and memory to assess cognitive status in older adults with cortical impairment; Halstead Category test, measures concept learning, flexibility of thinking and openness to learning. It is considered a good measure of overall brain function.

            There are many, many other tests available to neurologists who generally select a unique combination of tests for each individual based on their diagnosis and history. Neuropsyche examination results are interpreted by the disability in-house Neurologist, Neuropsychologist, or Psychologist. The Neuropsyche battery of tests are subject to interpretation, and of course, insurance physicians receive bonus incentives to interpret the results in favor of the insurance company.