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Long Term Disability Insurance Company Pushes for "Independent" Medical Exam

July 30, 2021

When individuals receive notice that their disability claim is suddenly being reviewed, and/or are being requested to attend an independent medical exam, confusion and fear sometimes occurs. While it is something you should not ignore, it does not mean that the claim will be denied or that your benefits will be disrupted. An independent medical examination can be an opportunity for you to provide important, relevant information to the LTD provider. This right to a medical exam emanates from a provision in the insurance policy with the insurance company.

Bear in mind that the idea that this is an “independent” examination is a misnomer. It is the LTD carrier that is deciding on the doctor to perform the exam, providing the questions to be answered by the doctor and paying the doctor. Often, a natural conservative bias results in conservative medical reports. With this in mind, here are some important steps that you can take to ensure a smooth process.

From a convenience viewpoint, initially confirm that the provider is within a reasonable distance to your location to attend the examination. “Reasonable” for purposes of an independent medical examination does not have a precise definition, but if it is more than 75 miles away from you, and traveling that far presents a challenge, you can ask to be provided with a consult closer to your home. The LTD carrier may fight about this, but with diligence, they usually can be convinced to find a closer consultative physician. Once there is an agreed upon provider, you need to confirm the date, time and location of the examination with the doctor performing the consultation. If you know you will not be available, do not delay, immediately contact the provider and the LTD carrier and request to reschedule the examination.

Clients frequently ask, “What should I know about this exam?” There are several things to be aware of. LTD carriers will often schedule surveillance of the claimant to occur the day before, the day of and the day after an IME as they are basically guaranteed to obtain footage of the claimant leaving their home. Therefore, you should treat this period of time as a prime opportunity to demonstrate your abilities and limitations. While you should always be operating within your restrictions, it is particularly important not to take any unnecessary risks or push outside of your limits during this window of time. Similarly, the day of the examination, and even before, you should presume that you are being observed from the moment you enter the parking lot of the building where the exam occurs, until the moment your vehicle leaves that same parking lot after the examination is over. This means that you may be observed in terms of how you exit your vehicle, whether you drove yourself, if you required a cane or walker to get from your car to the door of the building, etc. While in the waiting room, you can also assume that you are being observed. Consultative examination reports will often discuss whether a person was particularly social or loud while awaiting the exam, whether they were able to sit comfortably or were observed to be in pain, whether they had to leave frequently to use the restroom, etc. all before the actual examination ever starts. Once you are in the examination room, the assistant to the physician performing the exam and the actual physician will observe not only what you say and the clinical findings, but also your efforts, your demeanor and your physical abilities during the exam (i.e. did you have difficulty rising from a seated position, getting on and off the examination table, putting on and taking off your shoes, etc.).

All of this information is shared to show just how thorough the LTD carrier is in obtaining information to make a determination about your functional status. It is not simply a matter of what the doctor found when (s)he manipulated your knee or shoulder on exam. Additionally, prior to a consultative examination being scheduled, the LTD carrier often sends out an extensive questionnaire asking the individual to document their activities of daily living (i.e. what they do all day, what they can do, what they cannot do, what they require assistance with, etc.) Then, once the surveillance and IME are conducted, they will compare the information you provided on the questionnaire against the IME and surveillance information to determine whether what you said you could and could not do in your questionnaire is consistent with what was observed through surveillance and the IME.

There are a few specific recommendations that we typically make for how you can reduce risk, and help improve thee outcome in these situations. First, call us before - not after - the exam. Second, we recommend that you take copies of recent imaging (x-rays, CT scans, MRI’s, EMG’s, breathing tests, etc.) with you and give them to the IME provider. You dont need the actual x-rays etc, just the reports. The IME provider should have access to the medical record that the LTD carrier has, but it never hurts to insure they have the most important documents. Third, it may seem obvious, but do not be combative with the IME provider, and do not exaggerate pain. Nothing good will come from being disrespectful or hostile, and you can be assured that negative behavior occurs during an IME, it will be unfavorably documented in the IME report, and that report will become a part of the permanent LTD file. Similarly, many IME doctors are simply looking for an opportunity to show pain is exaggerated. Third, a great way to communicate how disabling your conditions are is to show how restricted your activities and lifestyle are. Let them know how difficult it is, for example, to fold clothes, or mop, or walk a block. Finally, and as always, stay off of social media. In the same way that being combative never helps, social media is almost always detrimental and a joke or a quip on Facebook can remove some of the legitimacy you have in your claim.

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