The Hidden Role of Independent Medical Exams in Insurance Denials

There are many state and federal programs designed to help folks who have challenges with taking on a job. Sometimes these disabilities are from genetic predisposition. For some, an injury, on or off the job, prevents them from returning to gainful employment. In any of those situations, the person who can’t work can apply for disability benefits.

This is where the concept of independent medical exams comes into play. Unfortunately, these exams could also result in a denial of benefits.

Are Independent Medical Exams Common?

Yes. If you are currently receiving a disability benefit, you may be summoned to take an independent medical exam (IME). It is understandable to be concerned, but the request for an IME is not uncommon. In fact, it is routine. In other words, there doesn’t have to be “probable cause”, and you aren’t being accused of wrongdoing. However, if requested, you are obligated to undergo the IME.

Failure to do so could put your benefits at immediate risk.

This is not to say that an independent medical exam is actually “independent.” In most cases, the doctor who will be conducting the exam has been selected by the insurance company. Does that mean the doctor will side with the insurance company? They might lean that way, but facts are facts.

That’s why you need to prepare yourself before the exam.

When an insurer relies on an IME to delay, reduce, or deny benefits without a reasonable basis, that conduct may constitute insurance bad faith, and a bad-faith insurance lawyer can help determine whether your rights have been violated.

What Should You Expect from an IME?

Although every IME is unique to the patient’s circumstances, there are some things you can expect, including the following:

• A 15 to 20-minute cursory exam that answers specific questions from the insurance company
• Completing a medical history form
• The medical consultant reviews documents provided by your treating physician (in some cases).
• The examining doctor will ask questions about your symptoms, previous treatment, and whether your condition is improving.
• The doctor will record or write their impressions
• Ask you to perform mobility tasks

The following suggestions are what you should implement for your IME.

Don’t Go to the Exam Alone

When you go to an IME, you will undoubtedly be going to a medical practice and doctor that you’re not familiar with. You should bring a trusted friend or family member. You should also ask that person come into the examination room. Unlike a general physical, the IME will focus on your disability and your challenges. You don’t need to keep anything secret from someone you trust.

Record the Exam

Although the medical professional might not like this idea, you should record your session. Nevada is a one-party consent state for recordings. That means you don’t need your doctor’s permission to record the exam, but it is better to let them know in advance. It is also important that your recording does not disrupt the exam in any way.

Don’t Change Your Story

Before you show up for your IME, the doctor will have an opportunity to review your medical history and the specifics regarding your current condition. You don’t want to change your story by overstating your level of pain and suffering. At the same time, you shouldn’t minimize your challenges either.

It might help if you review the same medical records your doctor will be looking at.

Keep Your Answers Direct

Although you’re not on trial, you don’t have to volunteer information that you’re not asked. If you’re asked a “yes or no” question, you only have to answer “yes or no.” You also don’t need to ask the examiner for their opinion or diagnosis. They are not treating you or prescribing medication.

They’re only looking for answers about the extent of your disability.

Talk to an Attorney

Before your IME, you should also discuss the situation with an experienced Reno insurance bad faith lawyer, whom you’ll find at the Law Office of Matthew L. Sharp.

We have advised many clients about the best approach for undergoing an IME. We have also been strong advocates for our clients to follow up with the insurance company to keep them in check. Requesting an IME is not a sign of bad faith, but it may indicate that the insurance carrier is trying to back out of a settlement. We will do everything in our power to keep that from happening.

Call to discuss your concerns today.