The Role of Independent Medical Examinations (IMEs) in LTD Claims and Litigation

In the realm of Long-Term Disability (LTD) claims, Independent Medical Examinations (IMEs) play a pivotal role. These examinations, often requested by insurers, can significantly impact the outcome of a claim and, in some cases, become a crucial element in litigation. In this blog, we delve into the multifaceted role of IMEs in LTD claims, examining their purpose, impact, and considerations for claimants facing these assessments.

Understanding Independent Medical Examinations:

IMEs are medical evaluations conducted by healthcare professionals who are independent of the claimant’s treatment team, or the insurer. Insurers typically request IMEs to gain a third party assessment of the claimant’s medical condition and its impact on their ability to work. Whether and to what extent these examinations are truly independent can be a point of contention however.

The Purpose of IMEs:

1. Assessing Disability: IMEs aim to provide an thorough and objective evaluation of the claimant’s medical condition and resultant functionality, scrutinizing the nature and extent of impairments to determine their impact on work-related activities.
2. Verifying Medical Information: IMEs serve as a verification mechanism, ensuring that the medical information provided by the claimant aligns is reasonable or consistent with the views of an independent medical professional.

Impact on LTD Claims:

1. Claim Denial or Approval: IME reports can influence the outcome of an LTD claim, leading to either the approval or denial of benefits based on the assessed level of disability.
2. Differential Diagnoses: IMEs may offer alternative diagnoses or challenge the severity of the claimant’s condition, creating a divergence of opinions between treating physicians and the independent examiner.
3. Treatment: IME’s may criticize the treatment or medication being prescribed by a claimant’s own treatment providers. It may suggest alternatives that may or may not be valid, effective or desirable.

Considerations for Claimants:

1. Preparation for IMEs: Claimants should be thoroughly prepared for IMEs. This includes providing comprehensive medical records, a detailed medical history, and preparing to discuss the impact of the disability on daily life and work.
2. Attendance and Cooperation: Attendance at scheduled IMEs is typically mandatory. Claimants should approach these examinations with cooperation and honesty to present an accurate portrayal of their medical condition. However, there is not an absolute requirement to attend an IME – whether that be on claim or during litigation. The IME must be reasonably requested (ie have some connection to the disability claimed or a basis for the request), must not impose physical or psychological harm to the person being examined, be at the insurers own expense, and not be employed more than is reasonably necessary. There are a litany of consideration though and an individual facing a request of an IME would be prudent to seek out legal advice prior to the exam.
3. Challenging Unfavorable IME Reports: In cases where IME reports are unfavorable, claimants have the right to challenge them. Engaging legal representation can be instrumental in disputing the findings and presenting counterarguments.

IMEs in Litigation:

1. Role as Expert Witnesses: IME practitioners may be called as expert witnesses during litigation. Their opinions may be subject to scrutiny and challenged by the claimant’s legal team.
2. Rules of Impartiality – IME practitioners during litigation are governed by the Rules of Civil Procedure. Their duty is technically to the Court and not the party whom retained they. They are bound by particulars standards of disclosure and impartiality. Of course, the reality can often be different and an experiences counsel can ensure the IME’s are conducted fairly and according to the
3. Building a Legal Strategy: Lawyers often use IME reports strategically in litigation, either supporting the claimant’s case or highlighting inconsistencies in the insurer’s assessments. It may be necessary or prudent for a claimant to seek out their own IME for use as evidence in their case. A qualified lawyer can find the appropriate expert to conduct this assessment on your behalf.

Conclusion:

Independent Medical Examinations wield significant influence in the trajectory of LTD claims and subsequent litigation. Claimants should approach IMEs with thorough preparation, transparency, and, when needed, legal guidance. Understanding the purpose and impact of IMEs is crucial for navigating the complexities of LTD claims and ensuring a fair assessment of disability that aligns with the claimant’s health and well-being.