Protecting Yourself in the IME Process: Reviewing the Policy

In this series, we are outlining some tips for claimants facing an Independent Medical Examination (“IME”).  Yesterday, we wrote about getting an attorney involved.  Today, we’ll explain another important step:

Make sure the exam is required by the policy.  This is another step where it is beneficial to have an attorney involved to review your policy.  Most disability insurance policies do have a provision that allows the company to have you submit to an Independent Medical Examination or Physical Examination.  However, sometimes those provisions aren’t totally clear on exactly what types of examinations are allowed.

For instance, here is a typical policy provision that your insurer might cite to tell you that you have to undergo an IME:

At our expense, we can have a physician of our choice examine you as often as reasonably required while your claim is continuous.

This provision states that the examination should be conducted by a “physician.”  Do you have to submit to a Functional Capacity Evaluation with a physical therapist?  The provision also states the examination should be “reasonably required.”  Has that qualification been met?

Here is another typical provision:

We shall have the right to have you medically examined at our expense when and as often as we may reasonably require while you claim to be disabled under this policy.

This provision says that you have the right to be “medically examined.”  Does that mean you can only be examined by a medical doctor?  Do you have to undergo a neuropsychological evaluation with a Ph.D.?  Again, has the qualification that the examination be “reasonably required” been met?

These are the kinds of questions you may want to get answered before you agree to the exam.

In the next post, we’ll talk about the IME intake forms.


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