How Insurance Companies Combine the Independent Medical Exam (IME) with
the Transferable Skills Analysis (TSA) to deny your ERISA long term disability claim.
One thing most ERISA disability insurance companies don’t want you to know is that they have a playbook of denial tactics used to protect their financial interests. It is one of the main reasons it’s so hard to prove your claim and win the disability benefits that are rightfully yours.
A common tactic we often help our claimants fight in their battle to win their disability claim is the IME – TSA insurance denial tactic.
The Strategy behind an IME – TSA Insurance Denial
Our video describes how disability insurance companies can get away with overlooking the medical evidence and opinions provided by your treating doctors and specialists. One of the strategies insurers use is to submit you to a medical exam performed by their chosen medical examiners.
This is called an Independent Medical Examination, or IME. It becomes the groundwork for the IME – TSA insurance denial strategy.
The purpose of these “independent” exams is to support their stance that you are not disabled — and save the insurance company a lot of money.
IME doctors are chosen by your insurer from a “go to” pool of doctors that they use. The exams can be very distressing for disability claimants. The examiners will evaluate you and ask many questions to gather information and evidence about you and the degree of your permanent disability caused by your medical condition. All of this can be used against you in an ERISA administrative appeal or in a lawsuit.
Basically the examining doctor is out to find that you have some ability to perform routine physical activities: sitting, standing, walking, lifting and bending. When the examiner finds a way to show evidence that you are capable of some physical activity, the conclusion can be reached that indeed you are able to work.
Claimants can be made to feel uncomfortable. Others may think the exam went just fine, and are stunned when the doctor’s evaluation declares otherwise. It’s not uncommon for the IME report to allege a claimant is feigning disability, including
- Faking they cannot perform tasks
- Not giving best effort during evaluations
- Exaggerated pain behavior and other symptoms
- Overstating symptoms
- Symptoms do not agree with the objective evidence (thus you are faking the pain, weakness or other symptoms)
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The outcome of the IME can significantly affect your disability case.
IME doctors do not play any part in your treatment, and so may be viewed by the insurance company and possibly a court of law as a more objective medical expert. For the unprepared, it can be difficult to undermine an IME doctor’s expert opinion.
Often the IME is done so that it becomes part of the administrative record. In ERISA claims, this is just another aspect of a disability claim that favors the insurance company. If the case goes to court, the court’s review is, as a rule, restricted to the administrative record.
The goal is for frustrated disability victims to simply give up and not pursue their claim. For the unrepresented claimant, that is often what happens.
Next Step in the IME – TSA Insurance Denial: the Transferable Skills Analysis (TSA)
The insurer will then use the results of the IME to prepare what is called a Transferable Skills Analysis, or TSA. The TSA is a key piece of evidence in the insurance company’s administrative record.
The TSA report assesses whether you have marketable job skills. Your work limitations (or lack thereof) stated in the Individual Medical Exam (IME) report is reviewed against relatable, actual jobs found in the “national economy” that tolerate those restrictions.
In other words, the TSA report will designate those jobs for which you have transferable skills. The insurance adjuster reviews that information to reach a decision to deny or approve benefits.
The decision to deny can be based on vocational assessment from the IME, which says that you can perform certain jobs in the national economy.
If you are already receiving benefits, denials are often based on a change of your functional status as observed in the IME. The insurance adjuster is now able to allege that, according to the TSA report, the IME results show that you are no longer disabled from performing any occupation.
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A Disability Attorney Can Help You Dispute the IME and TSA Reports and Fight Back
Don’t hesitate to get legal help if an IME and TSA are being used against you by the insurance company to deny, reduce or terminate the disability benefits you deserve. An experienced lawyer with the appropriate resources can protect you in many ways, including scheduling our own IME under proper legal and medical standards.
This is not the time to take chances. Call for a free case evaluation and find out how we can help.
Call or text 800-562-9830 or complete a Free Case Evaluation form
