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The Independent Medical Examination: The Unvarnished Truth

Whenever you place a physical or mental condition in issue as part of a disability claim, an insurer has the right to investigate it as part of its claim determination process. Insurers routinely require claimants to attend independent medical examinations (IME). Almost every policy contains a clearly defined provision requiring the claimant to attend such an examination or risk denial and/or voiding the policy.

The word “independent” includes the subdefinition of “not depending on another person’s opinion or resources.” There is no doubt that IME physician is dependent on the insurer for payment for this service. If you believe that the insurer has chosen the particular doctor for your examination since the believe the doctor is “fair,” then I have bridge in Brooklyn I want to sell you. Believe me, the fix is in on the examination. The insurer is not going to pay good money for bad results. They use the same examiners time and again to get the same result: evidence by which to deny your claim. For this reason, I always call these evaluations: “defense examinations” as there is nothing “independent” about them.

I actually have a court transcript which I said the following in a closing argument:

    Plaintiff attorneys have an unkind expression for doctors employed for medical examinations such as these. They are called “whores.” The expression itself is distasteful, but what offends me more is that it is grammatically incorrect. You see, a “whore” does it for free. Since the doctor in this case is very well paid for his services time and again, he actually is a “prostitute.”

The truth is that many of these doctors make a substantial portion of their income from their evaluation work on behalf of insurers. They have become very adept at disability terminology and will not hesitate to use their well-hone jargon against you in their efforts to please the insurer and keep the examination payments coming. These examiners have little compunction about overstepping their professional training to make sweeping statements to defeat your claim. Why? Because it is what they are paid to do. So, in Watergate conspiracy terms, you just need “to follow the money.”

If it is not bad enough that the insurers are willing to pay thousands of dollars each time you are examined, they will try to make additional demands on claimants in the process. To the insurer’s disadvantage, especially in more rural areas, they will not have a local doctor available to do their dirty work. They will schedule claimants to attend examinations hundreds of miles away. Worse yet, they will actually fly a doctor to stay in a local hotel to defeat your claim.

In almost every case, the examination will be a cursory affair with the physician undertaking a minimal interview and history, followed by a quick “once over” check of your condition, then will be on his way. The fact is that the defense physician wants to make sure not to find any evidence of your disabling condition. The defense physician is not concerned about your well-being, but rather the well-being of his bank account.

It is very common for the defense examiners to go beyond the medical evaluation process and to attack the credibility of your claim. To this end, they will use phrases such as “complaints are excessive for condition demonstrated,” “symptom exaggeration,” “secondary gain,” or the worse ever, “malingering.” The purpose of using this language is to make the claimant look dishonest which is easier to accomplish than trying to undermine the actual findings of the treating doctors.

To assist the doctor in this process, an insurer will hire undercover surveillance to film your attendance at the examination. The investigator will be waiting outside your home to keep watch on you for the entire trip. So, if you want to make some stops on the way home, all your activities will be taped and held against you. The videotape will be presented to the evaluating doctor who will be more than happy to make the blanket statements that your activities “were in excess of your stated abilities.” Do not put it past the examiner to watch you walk to the parking lot after the examination (or say that he did so) to make the same finding. Worst of all, you have no right to receive a copy of the report until after your claim has been denied.

How do you deal with these examinations? This is where a skilled counsel comes into play. I can honestly state that I have caused cancellation of more independent medical examinations to be conducted on my clients than have actually taken place. They have their tricks. I have mine, too. I also have no hesitation to call them to the carpet for use of the “usual suspects” to get favorable information to defeat my client’s claim. Aggressive stances are sometimes absolutely necessary in these scenarios. Since this type of work is all I do, I have gathered information on many of these “examiners” which comes in handy to defeat their dishonest pronouncements concerning my clients.

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