Insurance companies are once again utilizing the IME provisions in disability policies, therefore, I thought perhaps a reminder of a few important facts would be a good idea.
Have you ever heard the expression, “Those who can’t DO, TEACH?” This is certainly true of most IME physicians, some of which have very impressive credentials. However, in my 25 year experience, it seems to me that insurance doctors either don’t want to be in clinical practice preferring to follow the insurance money, or are retired from an insurance company, or are old and just do IMEs to keep the flow of money coming.
It is true, though, that for many insurance physicians “do no harm” quickly becomes “do as much harm as you can” when physicians leave their ethics at the door to write IME reports averse to insureds. Nothing about the evaluations is fair or objective.
It’s the same old story, “insurers looking to make profits by denying legitimate claims.” The word “independent” in IME, by the way, does not suggest “objective or fair”, but rather states the evaluator has never consulted with the insured in the past. Insurance IMEs are in fact NOT FAIR and are demanded so that yet another “illusionary appearing” piece of documentation supporting the insurance company’s decision to deny can be placed in the file.
It could be said that the “major strategy” of most disability insurance companies is creating illusion. In fact, insurance companies pay a great deal to physicians who do a good job creating adverse reports. At one time, for example, Unum had a Quality Review department that edited their physicians’ reports. I received a call from one of the Chief Medical Officers telling me he was fired because he wouldn’t change his report from support for the insured to adverse denial.”
There are actually insured out there who still believe IMEs are impartial. But, in reality, IMEs are based on a very short, in person consultation backed-up by review of the claim file. I know in the past, Unum used to inform the IME physician how much the insured’s monthly benefit was. Why do you think they did that? I don’t know if they still do it, but the higher the benefit, the more important it is to write adverse reports. Just saying.
IME physicians have no clinical history of medical treatment with the insured (beyond what’s in the file). Most IME insurance physicians write reports in favor of the entity signing their checks. During my expert witness days, I actually came across a company that trains neuropsychologists how to administer tests and write adverse reports, which were also graded, by the way. How is that fair?
Well, currently insurance companies are back in business with IMEs and I’ve already seen one report from Guardian that is so unfair it’s actually obvious. If you are asked to do IMEs be very careful; you may want to give me a call. I hope this information helps to clarify how unfair an IME really is. There’s nothing “independent” about it.
