Insurance Company Tactics: IMEs, Rushed Exams and Piecemeal Testing
Many policies allow insurers to conduct Independent Medical Examinations (IMEs) throughout the course of a claim. While the stated goal of an IME is usually to “verify” your disabling condition, insurance companies often use IMEs as a tactic for denying or terminating claims.
One such example of this is the case of Hughes v. Hartford. Patricia Hughes was working as a registered nurse when she began to experience vertigo and was diagnosed with Meniere’s disease. She ultimately filed a claim with her disability insurance carrier, Hartford. Hartford initially approved the claim; however, a few years later, they became particularly aggressive, interviewed her treating provider, conducted a field interview, hired an in-house doctor to review records, hired a surveillance company to follow Hughes, and terminated her benefits.
When Hughes appealed the denial, Hartford scheduled her to undergo an IME with a neurologist, Dr. Schiff, who concluded that Hughes’ test results were normal and that her diagnosis of vestibular dysfunction was inconsistent with the previously gathered surveillance footage. Hartford then used the report as a basis for upholding the denial, in spite of the fact that a nurse who accompanied Hughes to the exam stated that the examination was “very elementary,” “limited”, and “rushed”. Hartford also ignored concerns Hughes’s treating doctor raised about the exam—namely that Dr. Schiff was not trained in vestibular disorders and that Dr. Schiff notably “did not perform any of the tests which actually [had] been historically abnormal for Ms. Hughes including audiogram, video ENG, or posturography, so he seems to have omitted the most relevant data from his examination.”
Upon reviewing Hartford’s conduct, the judge determined that, under the circumstances, Hartford had not conducted a “full and fair review” and required Hartford to reconsider its denial of Hughes’s claim.
Every claim is unique and the discussion above is only a limited summary of the court’s ruling in this case. If you feel that your insurer is not giving your claim a full and fair review, an experienced disability insurance attorney can help you assess your particular situation and determine whether your insurer’s actions are appropriate.
 Patricia Hughes v. Hartford Life and Accident Insurance Co., No. 3:17-cv-1561 (JAM), 2019 WL 1324947 (D. Conn. March 25, 2019)