We’ve discussed IMEs here before and how insurance companies use them to deny claims and stop paying benefits for longer term total disability problems, both for people under individual and ERISA-governed policies. Below we’re going to detail several tactics that you can use to fight back against this practice and prove that the findings were incorrect, biased, or wrongly interpreted.
Ways to Prove Your IME-Based Denial Was Wrong
Make sure you get the doctor’s opinion. Insurance companies have a way of picking and choosing the parts of a treating physician’s report to further the argument that they can stop paying you benefits. One way to curb their ability to do this is to make sure that the doctor offers his or her expert opinion on your disability in addition to the rote facts uncovered in the exam.
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Look carefully at the report. As mentioned above, insurers are only interested in highlighting the parts of the report that tell the version of the story they want to tell. Because of this, it’s important that you work with a legal expert who can look carefully at the document and make sure that findings favorable to you are also being accounted for.
Examine the info sent to the IME provider. When insurance companies ask recipients to get IMEs, they send information about your case and condition to the IME provider. Some insurers will highlight information in your file that they believe might help to deny your claim or end benefits, but these kinds of tactics bias doctors against you. Additionally, you should ask to see the definition of disability your insurer sent to the doctor to make sure it matches the legal definition.
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Check out the doctor’s background. A legal expert in long term claims can help you to file discovery requests to determine how frequently this doctor works with the insurance company to do IMEs. If there’s a history there, it can be argued that the doctor is biased towards the insurer because they want to keep working with them. Experienced long term disability attorneys also know how to look into doctors’ backgrounds to see how much of their income comes from IMEs overall, because even if they’re not working for the same insurer, they may still have a vested interest in denying you to continue to get more IME work.
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Don’t think that a favorable IME will end this nonsense, either. Insurers are well-known for continuing to request that their long term total disability beneficiaries get IMEs until they finally find a doctor who will say that you don’t have a disability. Check out our free disability eBook to learn more about different policies and how you can fight for the benefits that you need.
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