23 hours ago A disability "Independent Medical Evaluation" describes the physical examination that a disability claimant is asked to undergo before an insurance company will either approve a claim or continue to pay benefits. The requirements for an IME are based on the provisions in the disability contract, and there may be some instances where the claimant does not have to comply with the … >> Go To The Portal
Patrick P. Mar 13, 2022 #11 Andrew, insurance companies will not typically provide a copy of the IME report directly to an insured unless there has been a formal denial of benefits. However, you can certainly request that a copy of the IME report be sent to your doctor for review.
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Thus, the brevity of an IME will not accurately reflect your functional impairments or ability to work. Unfortunately, most insurance companies do not consider whether an IME will accurately reflect your disability when they ask you to attend one. What Can I Do to Try and Make Sure My IME Is Fair?
Typically, IMEs are brief – the physician will interview you about your medical history and perform a short physical exam. For many claimants, that one-time, brief exam is not sufficient to fully and accurately determine their functional impairments.
It is no secret that IMEs are done under distress. Failure to attend will result in an automatic dispute of workers’ comp benefits. It can be a lose-lose situation because showing up also can result in a dispute of workers’ comp benefits.
Physicians who report that claimants are capable of going to work give the insurance company the information needed to deny or terminate a claim, and in return are retained to perform more IMEs. There are entire medical practices that do nothing but IMEs for insurance companies.
On March 19, 2019, the Appellate Division First Department issued a decision in which they held the notes of an IME observer were privileged.
IMEs usually take around 30 minutes, but could be over in 10 minutes. Make a note of how much time was spent. There is only so much “history” an examining doctor can absorb from one meeting with a patient.
In most cases, the insurance company is simply looking to verify key claims and statements as they evaluate how to compensate someone for the claim they've filed. A medical exam is one such way of verifying statements made about injuries, adverse impacts, and the compensation required to make those things right.
within 10 daysThe IME exam generates a report that is sent to all parties generally within 10 days. The report may or may not agree with your doctor and often will vary, especially in assessing your degree of disability.
After the IME, the doctor will write a report with his or her conclusions and opinions, particularly in response to the disputed issues or questions raised by the insurance company. You or your lawyer should receive a copy of this report. The results of the IME can have a large impact on your case.
If your treating doctor asks for a second opinion, it is either because your condition is outside of their area of expertise or you are ready for an IME. An IME or independent medical examination brings in another doctor to examine you and your medical records.
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Though your doctor conducts the examination, you're in charge. You can refuse any part of the exam, tests, or treatments ordered. Just be sure you fully understand the consequences of such a decision. Expect politeness, but respect the doctor's need to control the examination.
And this explains why a hospital charges more than what you'd expect for services — because they're essentially raising the money from patients with insurance to cover the costs, or cost-shifting, to patients with no form of payment.
Requests to record exams have generally been handled on a case by case basis. The plaintiff's attorney is allowed to be present at the IME, but New York courts have generally granted permission to video record an IME when there are special and unusual circumstances.
Medical reports: This usually takes about 6 weeks, but in some cases the delays can be significant.
IMEs are engaged when there is dispute or need to clarify the cause, extent and medical treatment of a work-related or other injury where liability is an issue. An IME is primarily requested by the employer, the insurance carrier or legal counsel.
When the independent medical exam is done, the doctors generally generate a report, correct? Is that report generally made available to the clients...
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If you are receiving long-term disability (LTD) benefits, the insurance company will periodically review your claim to determine if you continue to meet the applicable definition of disability. Often, this will involve obtaining your medical records and forms from your doctors to be reviewed by a nurse or doctor who works for the insurance company. However, sometimes, the insurance company asks you to attend an independent medical exam, or IME, in order to determine what your functional impairments are and thus whether you continue to meet the definition of disability . However, although these exams are labeled “independent” and performed by someone outside of the insurance company, there are several things you should be aware if your long-term disability insurer wants to send you for an IME.
If your long-term disability insurer has scheduled you for an IME and you are concerned about the impact it will have on your LTD claim, contact us now at (401) 237-6412 for a FREE consultation to see if we can assist you.
Although regularly conducting IMEs is not a definitive indicator that the provider will be biased, it is important to keep in mind. You should consider contacting an attorney if the insurance company wants you to attend an IME and you are concerned about the exam provider’s neutrality.
Often with these conditions, you are able to perform some activity but not on a reliable and consistent basis for several hours per day or multiple days per week. Thus, the brevity of an IME will not accurately reflect your functional impairments or ability to work.
You can sometimes argue that an IME should not be necessary and that you have provided enough medical documentation for the insurance company to make a decision, but if the insurance company continues to insist that you attend the IME, refusing to do so could jeopardize your claim.
For many claimants, that one-time, brief exam is not sufficient to fully and accurately determine their functional impairments. However, this is especially true if your disability is due to conditions that cause chronic pain or fatigue, such as fibromyalgia or chronic fatigue syndrome.
To further ensure that the appointment is as unbiased as possible, you can request to bring a witness to the exam who can later attest to the contents and results of the appointment . Additionally, you should request a copy of the doctor’s report following the exam.
In addition to the physician potentially looking for inconsistencies during the IME exam, a claimant must assume that he’s being watched prior to and after the exam as well. Cesar Gavidia stresses that it is quite common for a claimant to be under surveillance by a private investigator, either days before or just prior to an IME.
Since the medical examiner in an IME may not even know why you are there, it’s often the case that they haven’t yet reviewed your case and may be relying only on what you tell them at that moment. You may be there for a neck condition, an arthritis issue, back problems or any other number of disabling conditions – but this new examiner may be totally unprepared beforehand.
If the doctor writes a very unfavorable report, request your doctor review the report and make notes of the inaccuracies. Your treating doctors opinion may outweigh the opinion of the IME doctor, but this service is expensive, so consult a disability attorney before you go this route.
Of all the IME types, the neuropsychological exam is the most overused. It uses scientific tests to measure the brain functions from simple motor function, problem-solving, and reasoning skills. Then, the results are compared to “normal” test results. The most important thing to remember is this test measures the brain’s present level of functioning.
The purpose of psychological testing is to give you a rating on the AXIS scale and GAF scale. The GAF is a global assessment of functional rating. The GAF scale measures how well you are handling problems in living socially, emotionally, and occupationally. It has been around since the 1960s, and in 2013, it was dropped by the manual of psychiatrists and replaced with a rating scale developed by the World Health Organization, but insurance companies still use it and will probably not change anytime soon.
Although the functional capacity examination is a significant part of the disability claim process, they are not always the best for the insurance company. In fact, 40-60% of FCE is in favor of the claimant as opposed to only 10% of psychological exams in favor of the claimant.
It should expose those claimants who do exaggerate impairments. But in practice, the insurance company will use the IME to avoid paying benefits in valid claims. The process involves a physical examination performed by a medical doctor chosen and paid for by your disability insurer.
Certain impairments may cause you to have good days and bad days; symptoms wax and wane. If you tell the insurance company’s IME doctor that you can barely walk the 25 steps to your mailbox and back, and that you must always use a cane, make sure that is the case.
In fact, many disability policies contain language that stipulates if you fail to cooperate or attend the IME, benefits may be denied or suspended. Likewise, you have a right to a copy of the IME report.
The IME may conclude that your injury was unrelated to your work, that your injury is not as severe as your treating physician claims, or that you are physically able to return to work in a full or limited capacity. Based on these findings, your workers’ compensation insurer may try to deny your claim or stop your disability benefits. When a workers’ compensation arbitrator receives conflicting medical reports, they will use the report that they deem to be more credible. You can help your case by:
The IME doctor will give the workers’ compensation insurer an opinion on whether the workplace incident caused your injuries, the extent of your injuries, and whether you are capable of returning to work . Sometimes, the IME report will contradict your physician’s report, forcing you to settle the dispute with an arbitrator.
You may have appointments with multiple doctors after suffering a work-related injury. Your treating physician is your primary doctor who will diagnose your injuries, administer your treatment and monitor your recovery until you have reached maximum medical improvement.
IME doctors write summaries of medical records selecting what evidence to highlight. People are frequently asked to bring medical records and tests to the exam. Generally, individuals are not responsible to bring these items as the insurance company can obtain them on its own. A skilled lawyer can expose the weakness of the IME report if it was not based upon all the existing medical records or diagnostic testing.
Another one of the many IME doctor tricks they use is performing fake tests looking for pain when they know it is impossible for it to hurt given the type of injury. They try to expose people who might be exaggerating symptoms.
One of the IME doctor tricks insurance companies do is use the same doctors repeatedly because they know what to expect. Some exams take no more than 10 minutes. They do not provide any medical advice and just write a report with his or her findings.
It can be a lose-lose situation because showing up also can result in a dispute of workers’ comp benefits. It is a lonely place because family and friends cannot be present in the examination room. Individuals are not even allowed to record the encounter.
Doctors can quickly expose people who exaggerate or fake symptoms. Biased medical opinions can be challenged in court and we caution against picking a fight during the exam. We recommend writing down the details immediately following so this information can be used at trial.
It is not unusual for these doctors to comment on how someone walks or sits. Observations are frequently included within the independent medical examination report and can be used as justification to stop workers’ comp benefits. Never do anything beyond work restrictions because someone is always watching.
Michigan Workers Comp Lawyers never charges a fee to evaluate a potential case. Our law firm has represented injured and disabled workers exclusively for more than 35 years. Call (844) 201-9497 for a free consultation today.