If you have an open disability claim with an insurance company, there will likely come a time when they ask you to attend an Independent Medical Examination, or IME. This might seem frightening at first, and you’ve probably heard some horror stories. What I’m going to share with you today is what you must know before attending any IME, and how to prepare yourself beforehand.
This article is part of our Ultimate Guide to Long-term Disability Benefits.
It is also the first in a 3-part series about Independent Medical Examinations.
You can read the other two here:
– Independent Medical Examination: Tips for Success
– What happens after an Independent Medical Examination?
What is an Independent Medical Examination?
There is often a clause in disability insurance policies that allows the insurance company to get their own medical opinion about their clients. This is called an Independent Medical Examination — a professional assessment that will be used as evidence in your claim.
Every insurance policy has rules that set out the legal rights and obligations for each party. The insurance company has the right to get an independent medical opinion. As the insured person, you have to oblige when they make this request. There might be some limitations on their rights to do this; they may only be allowed to send you to a certain number of IMEs, for example. You would have to check your policy for a better understanding.
We generally recommend that you attend any and all Independent Medical Examinations that you are asked to — and I’ll explain why.
Why you should ALWAYS attend your IME
It might feel like there are plenty of reasons not to go. We’ve heard just about every excuse in the book.
To win your case, you need to actively work against the biases that the decision-maker has. If they believe in the myth of the disability cheat, they will be looking for any evidence that proves that you’re being dishonest.
So, you need to do absolutely everything in your power to prove them wrong. You should be attending Independent Medical Examinations — and not only attending, but bringing the most positive and helpful attitude you can muster.
If you’ve fleetingly considered any of the following reasons not to go, here’s how you can change your mindset about them.
I don’t want to go. If I don’t go, they won’t be able to prove anything against me.
Technically, you are free to decline an IME — but you have to be aware of the consequences. To put it simply, this is the easiest way for the insurance company to terminate your benefits.
In fact, outright refusing is like a gift to them. It’s a direct violation of the policy. Any violation of the policy allows them to terminate benefits, and they love to terminate for non-disability reasons. All they have to prove is that they asked and you refused. If you violate the policy, they can — and will — suspend or terminate your benefits.
It will always be better for your case if you go to the appointment in good faith. The worst thing that can happen is that their doctor will write something that isn’t in your favour. A good lawyer can fight the evidence — but they can’t fight that you unreasonably refused to attend.
The doctor has terrible reviews, a bad reputation, or doesn’t specialize in my disability.
Courts have interpreted the insurance company’s right to send you to an IME to also mean that they can choose whichever doctor they want. Unfortunately, you don’t have a say in the medical professional that you see.
If they choose a doctor who doesn’t deal with your disability, or is known to be biased, this will look worse for the insurance company than it will for you. It will come back to bite them — especially if you can prove it in court. And the more unreasonable the insurance company looks, the more reasonable you become.
If they intentionally choose a bad doctor, it can actually be a good thing for you. A doctor with a bad reputation can seem less believable to the judge. You should be more worried if they send you to someone who is very credible and trustworthy.
That being said, you should see whoever they send you to with an open mind. Don’t listen to the reviews you see online. IMEs can go in your favour no matter the doctor. We’ve seen doctors with bad reviews speak in favour of our clients. And if they don’t overtly speak in your favour, their report may be vague enough that it won’t be helpful to the insurance company anyway.
In any case, don’t be scared of an unfavourable report from the doctor. Your lawyer will fight it.
It’s a huge inconvenience for me.
You should know that making this appointment happen is going to cause some inconvenience in your life. It might not be easy, but there is really no valid excuse as to why you can’t attend. You basically have to bend over backwards to make it happen.
If you try to make excuses, the opposing lawyer will look at all the other things you can manage to do on a daily basis and ask: “Why not this?” The more inconvenient it is — the more problems and difficulties you have making this happen — the better it looks for you. Your entire claim will become more credible by showing that, despite your disability, you went to the appointment.
In fact, the bigger nuisance it is for you to attend the appointment, the more effort you should put into going. The more you do, the better you look.
Husband has to take the day off work to drive you there? Perfect.
Sister has to drive in from out of town to watch the kids? Fabulous.
If they order multiple assessments — even if they aren’t technically allowed to — you should just attend all of them. It’s more important that you attend and protect your credibility than to argue about legal technicalities or try to restrict information.
Going to all the trouble just to show up will really help your case — more anecdotal evidence about this in part 2!
It’s too far away.
Sometimes a policy will have travel-related limitations. Usually, the insurer can’t require you to go out-of-province or travel a very long distance unless they are willing to pay travel costs.
You still have to try, even if travelling is particularly difficult for you. Just like the rest of this advice suggests, doing everything in your power to get to the examination is crucial. If travelling takes a great physical and/or mental toll on you, the doctor will take note and your credibility will once again be bolstered.
How to prepare for an Independent Medical Examination
Get ready to talk about your disability, your symptoms, and how they affect your day-to-day. Know the rough timeline of your disability. Practice talking to someone about these things, if you need. If you’re anything like me, you’ve already been practicing monologues in the shower.
Answer questions — don’t offer information. The medical professional should be able to ask you the proper questions and prompt you for the details that they need.
You don’t need to bring notes, records, or documents. Your job is to give these things to the insurance company; it’s your insurer’s job to provide the doctor with the relevant information. Let the doctor base their assessment on what they already know, and what they learn during your examination.
If the insurance company sent very little to the doctor, or nothing at all, this might be a sign that they are trying to restrict information. Once again, this isn’t your problem. If the doctor’s opinion is formed while information is withheld, this reflects poorly on the insurer.
It’s best to go in empty-handed. Only bring something if the insurance company or doctor specifically asks you to.
You will have to fill out some paperwork. You might do this ahead of time, or at the beginning of the appointment. If you’re very worried about what you’ll have to sign, you can request to see the forms ahead of time from your insurance company.
Most notably, you will have to sign a release form to allow the flow of information. It’s more common now that insurance companies will hire a third-party agency to arrange the assessments. Information has to flow through that third-party agency in order for this to work. You should agree with that and sign the form. You can relinquish your consent afterwards, if you wish. Refusing to sign these forms is the same as refusing to attend. You might have your benefits suspended or cut off for not cooperating.
Plan ahead for getting there on time, and safely getting home. This appointment has the potential to take a lot out of you. Make sure you have a backup plan in case you can’t drive yourself home afterwards.
I know this article was a bit of a doozy — and it might not be what you wanted to hear.
I can’t stress enough that you need to be in the right mindset before you go to an Independent Medical Exam. You have to go in with the intention of cooperating and going above and beyond to be helpful to the doctor. You cannot go in to argue and act defensive because you read something bad about the doctor online.
Check back soon for the next article in the series:
What to expect during an Independent Medical Examination