If you have an open long-term 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, tips on how to prepare for the appointment, and what happens afterwards.
This article is part of our Ultimate Guide to Long-term Disability.
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 of 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 argue about legal technicalities or try to restrict information.
Going to all the trouble just to show up will really help your case.
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 them. 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 to get there on time and safely get 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.
Now that we have discussed how to prepare for the appointment let’s talk about some things you can do at the actual appointment.
IME Tips for Success: The Day of the Appointment
Remember, the IME begins the moment you walk out your front door
Honestly, this might be the most important independent medical examination tip you ever read.
It is highly likely that you will be under surveillance when you attend this appointment. The insurer might have someone watch you from the moment you leave your house to the time that you arrive back.
They do this because you will tell the doctor how you’re doing and feeling on that day — and that will all be on file. The insurance company will compare what you said to the doctor with how you acted when they saw you. Did you make it to your car easily? Did you struggle walking up the stairs to the doctor’s office? They will be watching for things that don’t match up with what you tell the doctor. If you say you can barely walk, you’d better be sure you don’t have a skip in your step when you leave.
The insurance company might give the doctor previous surveillance that they have collected. This is ethically questionable at best, but it could happen. If the doctor asks questions about specific dates and times, that’s what might be going on. Be honest and answer anything they ask. You always want to seem helpful and open. Try not to be defensive about what you’re being asked, even if you know that the insurance company was in the wrong by sharing previous surveillance with the doctor.
When you arrive
The doctor usually won’t know whether you’re under surveillance or not. Keep in mind, however, that the doctor and their staff will be watching you and reporting on their observations as well. This is obviously separate from the insurance company and not necessarily “surveillance,” — but you have to keep it in mind. If you claim that you can only sit in a chair for 10 minutes, but the staff observes you sitting for much longer while you fill out paperwork, that will be noted.
Speaking of which, you’ll have some forms to sign when you get there. You can ask your insurance company to show you the forms ahead of time if you’re worried about what you’re signing. The main one is a release that will allow your information from this appointment to be shared with the parties that need it. Obviously, this needs to be signed.
When you get into the exam room with the doctor, all you need to do is cooperate. Be pleasant with the doctor. Answer questions and make your very best effort during any tests that they need to perform. Even if you know that the effort exerted during this exam will have you in bed for a week, that’s not what the doctor will see. This is your time to prove yourself to the doctor.
IME Tips: Dos and don’ts
Don’ts
- Don’t fight with the doctor. Try not to act defensive when they ask you questions. Don’t ask, “Why do you need to know that?” or “Why is that relevant?” This isn’t the time to play lawyer and object to questions.
- Don’t go in with the mindset that you’re going to sabotage the assessment and leave at the first sign of trouble. If you do, you will either have to go back or you will be deemed uncooperative. The insurance company could very well interpret this to mean that you are refusing to attend and suspend or terminate your benefits.
- Don’t secretly record the conversation — especially if you’re involved in a lawsuit. We’ll have some tips on how you can take notes after the appointment in the next article!
Do:
- Do go in with the intention of being cooperative and helpful. Remember that this doctor can really help you. If you give them a bad impression by acting guarded, jaded, or cynical, you won’t be doing yourself any justice. Those are traits of somebody who has something to hide. You want to be respectful and show them
- Do push yourself to complete the examination. Show them that you are really trying. Once, a physiotherapist walked our client to her car and made notes of it, saying that he didn’t think it would be safe for her to drive home. If she had stopped the assessment partway through because it was too hard, this never would have happened. The physiotherapist wouldn’t have gotten such a clear idea of how taxing this was for her. The fact that she pushed through was critical for us to win that case.
- Do make yourself the best patient the doctor sees that day. If the doctor sees 10 people that day, and 9 of them fall under the “Don’ts” category, you should really be striving to be the good one. You will stand out against the others who come in with a bad attitude. This can be the difference in the doctor speaking positively about you in their report.
- Do be respectful and thank them for their time. Not all of these doctors are “hired guns” aiming to get you denied. Let them know that you understand how important this examination is for your case
- Do have a backup plan to get home safely if you push yourself too far.
What Happens After an Independent Medical Examination?
When does the Independent Medical Examination end? If you’ve read the previous sections, you might know what I’m about to say.
You should run with the assumption that the IME doesn’t end until you arrive safely back at your home. For one, the doctor and their staff will likely watch and make notes of how you seem when you leave the exam room. They will watch how you walk out.
If you happen to be under surveillance by the insurance company, there’s a chance that they will be watching to see what you do afterwards, as well. They might watch how you walk from the office to the car. They may wait at your home to see how you enter your front door.
You shouldn’t do anything that would contradict how you acted during the appointment. You probably won’t want to exert yourself too much, anyway. And yes, this probably means you shouldn’t make plans to meet someone for a late lunch after your IME.
In fact, there’s only one thing you should be doing: making some notes of your own.
Making notes after an IME
Once you leave the doctor’s office, you will want to make your own set of notes. Do this once you get to your car or when you arrive home. The sooner you write the notes, the better. If you write them sooner, you will remember things more clearly.
You can do this in the form of written notes, or you can take an audio or video recording. If you choose to take physical notes, take a picture of them with your phone afterwards so you have a timestamp that proves when that note was made.
You should make very detailed notes that summarize everything you remember. Here are some things you might want to make note of:
If you’re already working with a lawyer, include these notes in a communication to your lawyer. That way, your notes don’t have to be disclosed; they are protected because of lawyer-client confidentiality. Otherwise, if you take these notes, they will have to be disclosed if you end up in a lawsuit.
- What time did you arrive? What time did you leave?
- How long were you in the waiting room? How long was the examination itself?
- Did you have to do the paperwork? What was the nature of the paperwork? How long did it take?
- Were there other people in the waiting room?
- How did it go? What were your general impressions?
- Make note of the questions they asked you
- Also, make note of questions they avoided asking
- Summarize any thoughts the doctor shared with you
- What impression you got of the doctor and their attitude
- Anything else that was remarkable, unusual, etc?
We recommend making notes afterwards instead of secretly recording the appointment. Recording can hurt your credibility because it can appear underhanded. Maybe you do the recording on the off chance that the doctor wrongs you. If that happens, you have proof. You’re protecting yourself… right?
But do you really have to protect yourself?
The concern is that perhaps the doctor will say something that they don’t write in the report. You want to catch them contradicting themselves to hurt their credibility.
Now consider the other scenario: the doctor doesn’t say anything outrageous, and now you look sleazy for secretly recording it. The whole idea is that you go into the IME to show that you’re honest and straightforward. The act of hiding a recording can damage that perception of you. And you can’t just hide it forever. If you end up going to a lawsuit, you have to disclose that you did this recording.
Ultimately, it’s rare that you will capture the doctor saying something on the recording that doesn’t match up with the notes. We would say that hurting your credibility is more of a problem than the off-chance that the doctor will say something in person that they don’t write in the report. And even if the doctor does this, it probably wouldn’t be the sole deciding factor.
How do you ‘pass’ an IME?
You can’t really control what the doctor writes. You can only control your mindset and how you present yourself during the examination.
A successful outcome after an independent medical examination would be that you come out of it with your credibility bolstered. You want the doctor to think you’re a trustworthy and honest person, and hopefully, they indicate this in their report.
You will be able to see the report eventually, but you can’t demand it from the doctor afterwards. They do not have to give it to you or even send it to your primary doctor. The doctor performing the IME is just a third-party medical opinion for your insurance company — they don’t owe you anything. The report will go back to your insurance company, and it’s up to them whether they disclose it to you and your physician.
What’s Next?
Once the IME is all over with, you’ll just have to wait to see what it says. The insurance company will make a choice after reviewing their report — to continue paying your benefits or to cut you off.
All you can do at this point is relax and trust that you’ve done your best.
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