The Disability Insurance Claim Process
Independent Medical Exam(s) (IMEs)
An “Independent Medical Exam” is a process whereby an insurer chooses a physician or psychologist (depending on the case) to examine the claimant and provide the company with a medical evaluation.
Some insurance companies maintain lists of such experts in their own files; others use outside services specializing in consulting with insurance companies to do defense work.
Generally, when you receive an IME notice you must attend at a mutually convenient time and place. You should be cooperative, polite, responsive to questions and forthcoming. But do not let the evaluator twist your words. Take careful notes during or after the session and ask the Doctor to provide with a copy of the report. Some doctors will do so, others will not. Store your notes in your insurance Notebook.
If a video or tape recorder is used (different states have different rules on this) ask to be able to use your own recorder as well. (Bring one to the session just in case you need it.) Having a recording of what transpired can be very beneficial.
Always remember, an IME physician is not a treating doctor trying to help you. He or she is hired by the insurance company to provide information to benefit the company in its investigation of your claim.
A psychologist IME, when appropriate, can also be ordered by your insurance company. Such testing is appropriate when your claim is based on a mental or nervous disorder, or in some situations when the insurance company believes you may be malingering or exaggerating an injury or disease. Psychological IMEs can involve probing questions about your situation and personal details about your life. Such exams may also involve psychological testing such as the Minnesota Multiphasic Personality Inventory (MMPI).
Some psychologist questions may be valid in one type of situation but not in others. If you feel that questions are being asked that are inappropriate, you should politely decline to answer them until you can obtain expert advice as to whether the specific questions are proper or not.
Functional Capacity Evaluation(s) (FCEs)
A Functional Capacity Exam can also be ordered by insurers in disability claim situations. An FCE is an exam which attempts to test a claimant’s ability to perform the specific kinds of functions he or she would normally perform at work. Questionnaires are filled out and tests are given to measure the subject’s ability to perform specific maneuvers for specific periods of time. These tests are usually a lengthy. They are given by test administrators who are specially trained in this field. If you cannot perform a specific test without experiencing pain, you are not required to continue, and should politely decline to do so.
For any Independent Medical Exam, FCE or similar insurance company exam, it is important to remember to cooperate fully. Never exaggerate in anything you say or do in such exams. If you have the kind of injury or condition that is exacerbated or worsened by repetive maneuvers in a work environment and you have not been in that environment, IME are FCE testing may not be able to provide accurate results.
Disability insurance companies frequently hire investigators to do such things as take witness statements, conduct video or audio surveillance; and search court, hospital, employment and other records for information about a claimant. Be aware that this can happen. In most states it is legal.
In some cases insurers respond to claims disagreements by demanding to take a recorded statement from the claimant. If this happens you should prepare beforehand.