May 16, 2025 - Disability Insurance by Seltzer & Associates
When you’ve been paying premiums on a disability insurance policy and the day comes when you finally need to use that policy, it seems only fair that the process of filing a claim should be fairly simple. After all, you have a contractual arrangement with the insurance company that calls for them to provide benefits when you’re unable to work due to a disability.
However, professionals often find that when they file a claim, the insurance company finds reasons to deny benefits or delay the evaluation process. Often, they will insist on the need for an IME, which stands for Independent Medical Examination. It is essential to understand how the IME process works and its impact on your disability benefits claim.
An IME May Not Be Independent at All
An Independent Medical Examination is often a mix of fact and fiction. It is a medical exam, so that part of the name is accurate. However, to say that it is independent implies that it should be impartial. It generally is not.
The examination is not conducted by the claimant’s regular medical providers. In that sense, the examiner does not have the same knowledge and preconceptions as the claimant’s regular doctors. But the healthcare provider conducting the IME is not truly impartial and independent. They are generally hired by the insurance company or someone connected with the insurer. They are brought in ostensibly to evaluate a patient and assess their medical condition, as well as how that condition impacts the patient’s ability to work.
However, insurance companies often don’t want to pay benefits, so their goal when working with an IME is not to seek the truth, but rather to find a reason to deny a claim or discontinue paying benefits on a previously approved claim. This often leads to bias on the part of the healthcare provider conducting the IME. After all, when you don’t keep your employer happy, you’re not likely to do well in the position.
So, an IME may indicate that symptoms or disabilities are not as severe as the claimant asserts. Then the insurance company can use the IME report as grounds for denying the claim.
When IMEs are Used
Your disability insurance provider may schedule an IME to evaluate your condition as part of the assessment process involving your initial claim for benefits. Insurers also use IMEs in situations where policyholders have been approved and are receiving benefits to determine whether the policyholder remains eligible or if their condition has improved to the point where they can return to work. Many insurers require policyholders to undergo an Independent Medical Examination as part of the process of providing continuing proof of loss after they have been receiving disability benefits for a specified period.
An IME can be one of the most important factors in determining the outcome of a long-term disability insurance claim, so it is important to take a careful approach to the exam process. Many physicians, attorneys, executives, and other professionals are used to downplaying the symptoms and effects of their disabling conditions to be polite and positive. After all, it can be tedious and uncomfortable to hear about another person’s ailments.
But even though an IME involves interacting with a stranger, it is essential to be honest and accurate rather than polite. While exaggerating impairments can send up a red flag that can cause the examiner to reject everything you say, you need to avoid any tendency to discount your symptoms and their effect on your life. Don’t try to pretend you’re feeling okay if it has been a tremendous struggle just to get from the car to the doctor’s office. Allow your words and your body language to express how you truly feel.
An IME is Not the Same as a Visit with Your Own Doctor
When you visit your own doctor, the primary purpose of your visit is to receive treatment. Your doctor is there to help you. When you attend an IME, the doctor is not trying to improve your condition but simply to evaluate it.
Because the IME examiner is not providing treatment, you do not develop an official doctor-patient relationship with that healthcare professional. Statements that you make will not be kept confidential as they would be if you were talking to your regular doctor. Anything you say and do can be included in the report the examiner makes to the insurance company. It is important not to say anything that could be taken out of context and used to deny your claim. Even a comment made as a joke could provide grounds to deny or discontinue benefits.
While the IME examiner will be observing all aspects of your behavior, the examination need not be one-sided. Take notes about how the examiner interacts with you. If they do or say something unusual, record it. If they only spent two minutes in the room and never looked you in the eye, for instance, make note of that fact. If you can show that the exam was not performed properly or that the physician’s opinion could be suspect, you may have grounds to invalidate the findings of the IME if they produce a negative result. You can have someone attend the IME with you to take notes and corroborate your observations.
When the Results of the IME Conflict with the Findings of Your Own Physician
It is not uncommon for the physician conducting an IME for the insurance company to report that a policyholder is fit to return to work while the policyholder’s own physician knows that disabling conditions make a return to work impossible under the circumstances. In that situation, it is necessary to challenge the IME, and this is one area where a disability insurance attorney can prove extremely helpful. At Seltzer & Associates, for instance, we’ve focused on disability insurance issues for decades, so we know the most effective arguments to refute the incorrect reports from an IME.
It may be possible to challenge the doctor’s conclusion if they lack the proper experience with your particular medical condition. Or the doctor may have overlooked key information in your treatment records. In many cases, an IME will result in a negative finding based primarily on one piece of evidence that bears little connection with the disabling condition and its impact on your life. An experienced disability insurance attorney will know how to identify weaknesses in the report and effectively exploit those weaknesses in negotiations and, if necessary, in court, so that the policyholder can receive the benefits they are entitled to under the disability policy.
For Help with an IME or Other Aspects of Filing, Maintaining, or Appealing a Disability Claim, Call on Seltzer & Associates
When you’re unable to work due to a physical or mental disability, it is extremely frustrating to face miles of red tape before you can receive the insurance benefits you’ve been promised. Allow the team at Seltzer & Associates to take this burden off your shoulders. We are dedicated to helping professionals all around the country bridge the gap from disability to recovery. If you have questions about your disability insurance coverage or need assistance filing a claim, maintaining benefits, or appealing a denial, contact our team to schedule a free consultation to learn more about the assistance we can provide.