IME Doctor Tricks That Can Hurt Your Claim
If you have brought a personal injury claim or lawsuit, you may need to submit to an IME, or independent medical examination. Your IME doctor might have certain tricks to hurt your claim, such as performing fake tests, blaming pre-existing conditions, or blaming your injuries on other conditions. Having awareness of these IME doctor tricks can help you navigate your examination successfully. The purpose of an IME is to verify your condition and the effect on your daily life. While IMEs are supposed to be impartial, the doctor performing the IME is chosen by the insurance company. Because of this, the doctor is likely to tend toward bias on the insurance company’s side.
What Is an Independent Medical Examination?
An insurance company might require an IME if you make a personal injury, long-term disability, or social security disability claim. Usually, your treating doctor has recommendations about what medical treatment you need, whether you have suffered a permanent disability, or when you can return to work. These all affect the amount of your claim.
The insurance company that is liable to pay your claim might dispute these issues and require you to undergo an independent medical examination. This is an examination performed by another doctor who does not have a prior relationship or connection with you. Typically, IMEs are used for three purposes:
- Validate the level of your disability, limitations, or impairments
- Provide recommendations of treatments to help you recover, as well as future health risks
- Ascertain liability and causality
The purpose of an IME is supposed to be to allow parties to receive an unbiased, objective, and evidence-based view of your injuries or impairments so that the correct decisions can be made. This is why the IME doctor has no previous relationship with the person he or she is examining.
Many cases, especially if you have long-term disabilities for which you have a long-term disability plan, require regular IMEs. These can be performed by a variety of different types of doctors, including psychiatrists, neurologists, surgeons, chronic pain specialists, or any other type of specialist required to evaluate your current condition.
These ongoing IMEs are performed for various reasons. It could be because you have not been evaluated for a while, and the insurance company wants an updated evaluation. There could be indications that your condition has changed, or the insurance company has noted red flags in your claim.
Sometimes an IME is requested because the insurance company is looking to deny a claim. When injuries worsen, you might request an IME to reopen a closed claim.
What Happens During an IME
In preparation for the IME, your medical records and all relevant documents, including injury reports and statements that you have given, will be sent to the IME doctor. The doctor will likely perform a physical exam and ask you questions.
You should be prepared to answer questions about the following: your health, medical injuries, and previous injuries, as well as previous treatments. They may ask whether you have recovered from previous injuries or sustained lasting disabilities from them. You may also need to disclose details of the incident giving rise to your current claim, the cause of your current injuries. If you still suffer pain from your current injuries, a detailed description of the pain, its regularity, and what brings pain relief may be necessary.
The IME doctor may also ask:
- If you can perform daily activities, and if not, the reason for not being able to do so
- How long you were off work after the incident, whether you can return to work, and if so, if there are any limitations
- If there will be future medical treatment for your injuries
- Whether there have been any accidents or injuries since the incident, and details of related medical treatment
The physical exam is not to determine the state of your overall health. It is to consider specific injuries in question, so it might not be as long or comprehensive as an exam you might receive from your treating doctor. However, it’s in the best interests of the insurance company to be thorough since large payouts can be at stake. The doctor will look for signs that your physical condition corresponds with the description of your injuries.
Following the IME, the doctor will provide a written report for the insurance company. This report gives the doctor’s opinions about your injuries, the cause, and extent of them, and how they might affect your daily life. This report will have a significant impact on your case or claim, as the IME doctor is seen as an expert, and is generally considered more impartial than your treating doctor.
These IME Doctor Might Hurt Your Claim
The IME doctor is supposed to be impartial, giving an objective assessment. However, whether the doctor is biased may depend on how he or she is selected. The IME doctors are usually selected by the insurance companies, and so have incentives to minimize your claim, saving the insurance companies costs.
There are tricks that doctors might use to support the insurance company’s interest:
Reporting Additional Details to the Insurance Company
There is no expectation of a normal doctor-patient relationship during an IME. What you say to the doctor is not privileged and could even be used against you. The same goes for observations that the doctor makes. For example, if you claim to have pain, and favor a leg during your IME, but the doctor sees you walking normally after the IME, he or she will make a note of that. It’s best to always act with transparency.
Speculating on the Causes of Your Injuries
The doctor might try to find causes for the injury that is outside your claim. For example, you may have shoulder injuries, but the doctor suggests your shoulder pain is from playing too much golf on the weekends.
Performing Fake Tests
A doctor might perform a test for pain in a way that is not possible with the type of injury. This is to expose if you are exaggerating or faking symptoms. It is important to be honest during an IME.
Blaming Pre-Existing Conditions
A doctor might look for old injuries or conditions to blame your symptoms on. Be prepared with information about your previous injuries, and how your current injuries have altered your physical condition. Thorough medical records can assist with this, as they will show the difference between your condition before and after your injuries.
How to Handle a UNUM Medical Exam
UNUM is an insurance company offering term and whole life insurance policies for employees. UNUM often requests mandatory IMEs for their customers. Since the IME can be critical in having your benefits claim approved, you should take certain steps to make sure that you handle the exam properly.
Arriving early gives you enough time to complete any paperwork beforehand and allows the exam to start promptly. It gives the doctor enough time to perform a thorough examination. This will also set a good impression and get you off to a good start with the IME doctor.
Dressing appropriately can show that the IME is important to you and that you are taking it seriously. Depending on your injuries, the doctor may request you to change into a medical gown, so make sure to wear clothes that will make that easy.
You should also be sure to wear clothes appropriate for your injuries. For example, showing up to an appointment in high heels while you are claiming to have an ankle injury will not be wise. If you have been prescribed medical equipment such as a sling, crutches, or a brace, be sure to have these at the IME. Don’t bring them if you don’t require them, as exaggerating your symptoms will hurt your IME. Make sure to wear clothes and equipment consistent with your injuries.
Take Someone With You
You have the right to bring a family member, friend, colleague, or even attorney with you to the IME. This provides a witness who can observe and document what happens during the IME, which can be useful if any issues should arise.
Be Prepared to Explain, and Be Honest
You should be aware of what questions the doctor is likely to ask so that you are able to explain your answers clearly and accurately. You can review medical records to prepare and make sure your answers are accurate. Always be honest. Also, be aware of what not to say during an IME:
- Don’t exaggerate symptoms.
- Don’t omit details about the incident.
- Disclose all relevant information about past injuries.
If something hurts, say so, and if you cannot perform a task, let the doctor know.
Consult With Your Attorney
An experienced attorney can prepare you for your visit, help you navigate the process, and discuss your options if you are unsatisfied with the IME report. An attorney can make a big difference in helping avoid IME doctor tricks, and getting you a satisfactory result.