Now that all insurers are engaging in questionable claims practices, it’s time to remind readers of “best practices” for Independent Medical Evaluations. IMEs are perhaps the number one source of profit risk management. Therefore, it’s time to remind Readers what they can expect when they receive the ultimate IME request from their insurers.
I do have a White Paper written on the subject available to my clients because they sign confidentiality statements with me not to publish my proprietary information on the Internet. However, some information may be helpful to you.
The word “Independent” in IME does NOT mean these evaluations are fair and objective. It only means that the IME evaluator is a doctor who has never treated you before. The “title tag” stuck, and unfortunately there are insureds who think an IME is an objective, fair evaluation. But, it is not.
Today, in a much more organized, sophisticated form than in the past, physicians who perform insurance IMEs are part of an IME network of doctors who work for the insurance industry, workers’ compensation, and personal injury attorneys. These physicians are trained by their networks on how to prepare IME reports of benefit to whoever is paying them for the evaluation. Of course, the IME networks portray an semblance of propriety, and fairness, because they are also called to testify in court when asked to do so. These networks are one stop shopping for the insurance industry.
In fact, the insurance industry has perfected the art of using the IME as a means of discrediting disability claims to the point that profits soared in the millions. I am already seeing evidences of insurers such as Reliance Standard requesting IMEs without having reviewed all of the available medical records. Reliance Standard has an IME Network that schedules the IMEs without notice and with short scheduling dates, such as three days notice to the insured.
All disability Plans and policies on this planet include “mandatory” provisions requiring IMEs when requested. Therefore, insureds DO NOT have a choice to attend or not. Non-attendance will result in a claim denial. Here is a bit of advice you might want to think about if your insurer is requesting an IME.
- You can’t talk your way into an approval report. Some people seem to think they can talk the evaluator into giving an approval report. Save your breath. In fact, best practice for IME is to answer only when the physician asks a question and then BE QUIET. The less said, the better.
- Bring a witness. Insurers are now leaving it up to the evaluator whether or not they will allow a witness into the room. Bring along someone who can be there with you and insist the witness be allowed in the room.
- Ask the evaluator how many insurance exams he’s performed in the last 6 months. He may or may not tell you.
- Ask the evaluator if he/she has read your file. Medical information from your file has been provided to the IME evaluator, but unfortunately sometimes they don’t read it prior to the evaluation.
- Ask for the CV of the evaluator before the IME and make sure he/she is qualified to examine you.
- Don’t exaggerate your symptoms. “Waddle Signs” tells the physician whether you are exaggerating pain. For example, the doctor may push on your back in a location that couldn’t possibly hurt you, and you yelp “OUCH!” It’s a sign of pain exaggeration.
- Remember the IME physician is NOT your treating physician and should never recommend treatment. He/she doesn’t have your complete history and should not tell you how to be treated.
I hope that this information will get your thinking about the IME process.It is not a fair or objective evaluation, and it’s important to make sure you’re rights are protected. If you have any questions, please fee free to contact me.
