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What Are Independent Medical Examinations (IMEs)?

What Are Independent Medical Examinations (IMEs)?

When individuals apply for long-term disability benefits from their employer-sponsored and ERISA-governed disability plans, insurers must make a determination as to whether they meet the required definition of disability in order to qualify for benefits. One tool that insurance companies use to make this determination is the independent medical examination (IME), which is designed to give the insurer a separate medical opinion from that of the individual’s own treating medical providers. Participation in an IME at an insurer’s request during the long-term disability claims process is typically a requirement that is specifically set forth in the insurance policy. This means that you have little choice but to attend the IME if you wish to pursue a claim for benefits.

Although these IMEs are supposed to be “independent,” or free from the influences of others, the reality is that the doctors who conduct IMEs are paid by the insurance companies who hire them. Insurers often use the same doctors on multiple occasions for the same purposes, and some doctors earn a substantial portion of their income from conducting IMEs.

In practice, IMEs are often fairly cursory physical examinations in which the IME doctors review your medical records, ask few questions and simply record their opinions of your disabling medical conditions. As compared to the opinions of your own medical providers, who often have treated you for years, the outcomes of IMEs should carry little, or at least a lesser weight. However, insurance companies routinely rely on these medical opinions as a basis for denying your claim for long-term disability benefits. These IME reports can often be used against the insurance company during an appeal if there are major discrepancies between the IME doctor’s findings and your treating physician’s opinions.

In many cases, insurance companies also use the IME as an opportunity to perform surveillance on claimants as they travel to and from the IME location. Investigators may photograph or videotape you and any activities in which you are engaging on the date of the IME, simply because they already know where you will be at a specific time. This is not to say that investigators will not conduct surveillance on you at any other time, but the IME is one time that you may expect it to occur more so than other times.

Bonnici Law Group has handled the claims of countless individuals who have encountered difficulties in procuring long-term disability benefits under their employers’ ERISA-governed insurance policies. We will protect your rights and advocate on your behalf throughout every stage of the claims process. Call our office at 858-261-5454 to set up an appointment to speak with us today.

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