Your family doctor is rarely the only medical professional you will see after filing a claim for long-term disability (LTD) benefits.
In addition to the specialists your physician may refer you to, it’s also possible that your insurer will ask you to attend an independent medical examination (IME) at various stages of the claim process.
Many injured workers are understandably wary of the prospect of an assessment by a medical professional who does not know them and was selected by someone else. However, with the correct preparation and the help of long-term disability lawyers, an IME does not have to be a scary experience.
Here are the frequently asked questions I often get asked and my answers for you.
1. What is an IME?
An IME is a medical assessment carried out on an LTD claimant by a third-party professional with no history of treating them so that they can deliver a neutral opinion on their condition.
Some argue that the term “independent” in IME is a misnomer, since the insurer selects and pays for the person carrying out the assessment. And while some companies may request an IME to avoid paying benefits, the purpose is usually more about painting a fulsome picture of a claimant’s injuries and filling in any blanks in their knowledge of your condition.
2. Do I have to attend?
The answer to this question depends on whether you are currently receiving benefits from your insurer or have launched a claim against them in court.
In cases where the IME was requested for an individual in receipt of benefits, the terms of your LTD policy will dictate whether and when you must attend. Attendance is usually mandatory, but if the policy does not stipulate the insurer’s right to request an IME, you may not be required to go. Still, if you’re unsure, it is best to check with an experienced long term disability lawyer in Oakville.
If you have already begun litigation to challenge an insurer’s decision to deny or terminate your claim for LTD benefits, different rules apply, and you will likely have no choice but to attend an IME requested by your insurer. You can read more on that process in question six.
3. When do insurers request IMEs?
An IME request could come at any stage following an application for LTD benefits. Most commonly, they arrive in the immediate aftermath of a claim or in the lead-up to the two-year anniversary of the first payment, to establish whether the claimant still qualifies under the new test for benefits.
Most LTD policies initially require injured workers to show they are totally disabled from performing the essential tasks of their “own occupation” to receive benefits. After 24 months, claimants must typically meet a more stringent test requiring them to demonstrate that they are unable to be employed in “any occupation” they could become qualified for.
4. How should I approach an IME?
While I understand claimants’ suspicion of a physician appointed by their insurer, it is never good for their case to adopt an uncooperative attitude during an IME.
I advise clients to approach the examination as if it was being performed by their own doctor, which means communicating in a pleasant, respectful and candid way about their condition, their treatment, the activities that are difficult for them, and the impact their symptoms have had on their day-to-day life.
Frankness is particularly important for those with a psychological element to their claim, even though I know it can be challenging to open up and explain your mental health problems to a stranger.
You should also bring a list of all the medications you are currently taking and refresh your memory about your health history, so that nothing is left out and the assessor can take an accurate snapshot of your current condition.
5. What should I do afterwards?
At the end of an IME, make notes about how things went and jot down anything you think stuck out or was unusual about the assessment.
You should also request a copy of any report that the IME examiner will provide to the insurance company, as you are entitled to see the details of their assessment, as well as any conclusions and recommendations they make about your condition or your ability to work.
6. What is different about an IME during litigation?
When an LTD claimant launches litigation to challenge a denial or termination of benefits, the rules of court entitle the insurance company to have the injured worker assessed by an expert of their choice, who may even appear at trial to give evidence on their opinion if the case gets that far.
In these cases, the insurance company has much more leeway to set out the parameters of the assessment, the type of specialist you see and the questions for the expert to answer in their report.
Many of the same tips for the claimant’s approach apply to this type of assessment, and their lawyer will be able to guide them through the process.
If your insurer has asked you to attend an IME or you have any other concerns about your LTD claim, contact me or another member of the team at Edwards Pollard to speak with our long-term disability lawyers.
