Independent Medical Assessment: Tips From a Lawyer

Independent Medical Assessment: To be or not to be assessed

Many individuals who are receiving disability benefits will at some point or another be asked by their insurance company to submit to an independent medical assessment (IME) or examination.

An IME is meant to be an objective, third-party medical examination, conducted to essentially determine whether you, the individual who is getting benefits, is disabled and cannot work.

These assessments are not done by your own medical team. The assessor is also selected and paid for by your insurance company. It is therefore not surprising that disabled claimants – like you – have a valid degree of skepticism about the process.

Do I have to attend an Independent Medical Assessment?

As disability lawyers, we are regularly asked by disabled claimants whether they have to attend an IME if an insurance company asks for it.

Unfortunately, most insurance policies are drafted to favour the insurance company and include provisions that require a disabled claimant to submit to an independent medical assessment if required. As a disabled claimant, you are required to cooperate with the insurer to arrange and attend the IME.

In some instances, travel arrangements to and from the assessment can and will be made for you by the insurer. The IME itself can also take different forms depending on the nature of the assessment. For example, some physical assessments (also called Functional Ability Evaluations or Functional Capacity Evaluations) can occur over two days.  Some assessors prefer to have a brief interview on one day and the fuller assessment, with examination and testing on a second day.

Our advice

Although you have a duty to cooperate and submit to an evaluation, there are some steps you should take when an IME occurs. The following is advice we give to all of our clients when asked about the process.

• Make a good record for yourself about the IME: Record how long the assessment took, what happened during the assessment, what was asked of you, what you said, and how you felt during and after – even the next day. The conclusions of the assessment will be made without knowing your experience after, later that day or the next day, which could be significant to rebut the inevitable assumption that your capabilities observed over several hours is indicative of a sufficient capacity to maintain sustained work day in and day out.
• Ask for a copy of the IME report: After the assessment takes place, ask for a copy of the report form your case manager or insurance adjuster. You will not automatically get a copy and some insurers go so far as to refuse to give you a copy directly. Instead, what the insurer might do is to say they will provide a copy to your treating doctor(s). Make sure this is done, so that you can then get a copy from your own doctor.
• Go through the IME report yourself and take notes: You are looking for inaccuracies in your review. Read carefully and look out for any inaccuracies on your medical history or what you reported to the assessor or even what happened during the assessment. After that, give this list of inaccuracies to your case manager or insurance adjuster.
• Get a rebuttal report: If the result or conclusions of the Independent Medical Assessment are not favourable – in other words if it says you are not totally disabled and you can work – then give the report to your own medical team to provide their comments. Ideally, your primary treating doctor or specialist can then prepare a report or letter for you responding to the IME results, stating again that you are totally disabled and cannot work. You can then present this to the insurer to attempt to resist the inevitable decline of your disability benefits.

When to contact our disability lawyers

Ultimately, the true goal for the insurer with an IME is to form a basis to undermine what you and your own medical team is saying about your health, your functional limitations and your inability to work.

An IME will no doubt comment on any treatment options that you should undergo or medication that you should take. This way the insurer can rely on the terms and conditions of the disability policy to justify cutting off your benefits for one reason or another.  If this were to happen, do not hesitate to call our firm or contact us with your questions about the process and your rights; we are happy to speak with you.

We also encourage you to leave any and all questions anonymously at MyDisabilityQuestions.com, where a disability lawyer will provide free answers.