By Peter Casciano, Esq.
IME stands for Independent Medical Examination. These exams are generally scheduled by an insurance company when evaluating a claimant’s disability claim. They can either be used by the insurance company when processing a claimant’s initial long term disability (LTD) claim or when reviewing the claim to see if continued LTD payments are appropriate.
Much has been written about the fairness and accuracy of insurance company IMEs. Some are of the opinion that every IME is performed by a “hired gun” physician that will always result in an unsupportive report. Others naively think that all they need to do is tell the IME doctor about their issues and it will result in a supportive report. The truth is probably lies somewhere in between.
Guidelines for Understanding Your IME Results
First, in order to evaluate whether your IME will help or hurt your case, it’s important to know if the IME doctor possesses the knowledge required to evaluate you. Are they board certified? Do they have a specialty? Subspecialty? These are critical threshold questions that must be answered in order to properly read an IME. Generally, if the IME doctor is issuing a medical opinion in a field outside their scope of practice, it should be easier to refute and rebut.
Next, the actual testing performed by an IME doctor must be analyzed and researched. For example, in orthopedic cases, a typical test is analyzing the range of motion test on the relevant part of the body. For those kinds of tests, the medical community is generally settled on what a “healthy” range of motion is. Sometimes, we see IME reports where the range of motion exams show many scores outside the range of what is medically accepted, yet the conclusion opines that the individual is not restricted. This contradiction can be used to impugn the credibility of the IME physician.
Another question to ask is: what medical records did the IME doctor rely on in order to formulate their opinion? Very rarely are the IME opinions based solely on the in-person exam. Usually, the IME doctor will receive the records ahead of time so that that the doctor has a background on the LTD claimant. If key records are missing, especially previous testing, an argument can be made that the IME doctor was blind to one or more areas of the case, or that the IME doctor’s opinion is incomplete.
Remember, the IME doctor should be able to articulate the reasons for their conclusion. If the IME doctor issues an unsupportive conclusion, the critical task is to figure out why. I recognize this is not exactly earth shattering advice, but in practice it is not always easy unpacking the IME doctor’s rationale. Were there symptoms the IME doctor was looking for that would have allowed them to support the claim? Should a specific set of tests been done by the treating physician that were never done? Answering these questions should lead to the IME doctor’s rationale for their opinion.
Lastly, and this is not always easy to find, it’s very helpful to learn your IME doctor’s reputation in the medical community and in the insurance industry at large. Do they only work for insurance companies? How many IMEs do they perform per year? Have they ever issued an IME that was the subject of litigation, good or bad? Do they also continue to treat patients? All these questions are relevant and could provide helpful information depending on the circumstances of your LTD claim. If you have questions about your IME or the LTD process in general, please contact me for a free consultation.
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