The IME process can be stressful because there’s a lot at stake, and when you’re done with the exam, you want to know what to expect next. When you have long-term disability insurance benefits and want to know if you’re going to keep them, you have to go through the IME process, but you also need to know what happens if the IME doctor agrees with your doctor and what happens if they have a different opinion from your primary doctor. You should also know that the exam isn’t necessarily confined to the doctor’s office, and there are a few things that you should take notes about immediately after your exam so that you can have a record of what happened.
What Is an IME?
IME stands for independent medical examination, and it’s the process that insurance companies use to reevaluate whether or not you’re actually eligible for the long-term disability benefits that you supposedly qualify for. During this process, a doctor looks at your previous medical records and does an examination on your to determine whether or not you fit the qualifications. The IME doctor could also order more tests to determine your health status. The doctor will then use this information to determine whether they agree with your personal doctor or not.
One of the most important things that a claimant needs to understand is that these medical exams aren’t as independent from the insurance company as they might sound. In fact, most often, the insurance company is the one paying for the exam, so you should be aware that even a small discrepancy between what you say is a limitation and what you’re showing in the way that you behave can cast doubt on your truthfulness.
When Is the IME Over?
You need to be careful when you leave the doctor’s office where your IME evaluation is done. More than likely, the doctor and other staff members will be watching the way that you act as you leave. For instance, if you came in with a limp and suddenly don’t have it when you walk out the front door to the clinic, there’s a good chance that the doctors are taking note of that, especially if this information affects your claim.
Additionally, if your condition would prohibit you from driving a car, walk up a flight of stairs, or do any other activity that you might need to do to get home, know that there might be someone watching you to see if you do these things. In fact, there might even be people from the insurance company surveilling you at your home, watching you as you walk inside your house. As a result, you shouldn’t consider the IME to be over until you are completely behind closed doors in your home. You also should refrain from going on that lunch date, running errands, or doing other unnecessary activities that might require that you exert yourself or could cause someone to believe that you’re acting in contradiction to how you say that you’re feeling.
Things to Note About the IME
When you undergo an IME, you’ll want to take notes during and immediately after the exam so that you can be certain about what happened and what was discussed and know if something in the report doesn’t sound right to you later. You might choose to take notes on a few important issues when you get to your car, or you might choose to wait until you’re home if you live near the doctor’s office.
Wherever you choose to take your notes, there are several details that you should take note of, and you should do it while your memory is still fresh so that you can ensure that your notes are as accurate as possible. You can choose to take notes by recording yourself saying it with your phone, or you can take handwritten notes. But if you choose to take notes with pen and paper, take a picture with your phone, too, so that you have a time-stamped record of when you wrote those notes so that it’s less likely that someone can accuse you of having forgotten and taken inaccurate notes.
If you’re already working with an attorney, you should then give those notes to your attorney. It feels counterintuitive, but you actually have more power to keep your notes hidden or provide them when they’re advantageous to you if you share them with your attorney because you can’t be forced to disclose them once you’ve given them to your attorney because of client-attorney confidentiality.
There are several things that you should take note of. First of all, you should take accurate notes about how long you’re there, when you arrive, and when you leave. Some other details to note include how long you were in the waiting room, if there were any other patients waiting with you, details about any paperwork you were asked to fill out, what questions the doctor asked you, your general impressions, any information that the doctor shared with you, and anything unusual that you noticed. (You can read more in our guide to handling an IME.)
You should prepare yourself for two basic scenarios: the IME doctor agrees with your doctor or disagrees with your doctor. If the IME doctor agrees, you might wonder if that means that you’re free and clear and will continue to receive the benefits that you were set to receive before you were asked to complete the IME. For the most part, this is true. If the IME doctor agrees with your doctor in terms of the treatment that you’re receiving and your overall abilities and disabilities, your employer will act in accordance with what the IME doctor has proposed for your treatment in the workplace. On rare occasions, an arbitrator will need to get involved to enforce a decision because either the employer or the insurance company is not willing to go along with what the IME doctor and your doctor both agree on.
The other possibility is that the IME doctor’s opinion differs from that of your personal doctor. In this case, the insurance provider can stop paying your claim. The insurance company can also authorize your employer to accommodate work restrictions so that you can continue to work with modified arrangements, or they can also say that you need to have additional treatments before you can be considered for benefits again.
There might also be an arbitrator, who will decide whether the IME doctor or your doctor is more credible. Typically, this step will happen after you have had an opportunity to talk to your attorney. Additionally, if you don’t agree with the IME doctor, you might be able to challenge their decision if they made it based on incomplete, incorrect, or outdated information. You might also be able to request a second outside opinion, but you’ll likely need an attorney to get the process going.
How We Can Help
There are several ways in which the team at Osterhout Berger Disability Law can help you receive the benefit you deserve. We help individuals who need to…
- Apply for Social Security Benefits and want to ensure everything is done right the first time
- Appeal a denial of Social Security Disability Benefits
- Appeal an existing denial of Long Term Disability (LTD) Benefits
If you are facing one of these situations due, please do not hesitate in reaching out. Our team of experienced attorneys are here to help, and your consultation is free.
Afterwards, the IME physician will write a report for your insurer based on their examination. This report will provide their opinion regarding whether your medical condition prevents you from working. Your insurer can use this report as evidence when determining your disability claim.What distinguishes a good IME report? ›
Put simply, reason is indifferent to results. If the report is well-reasoned and well-supported, regardless of the favorability of the opinion, it is a good report. When evaluating an IME report, consistency matters.How long does it take to get an IME report back in Pennsylvania? ›
The entirety of the examination can last anywhere between 15 minutes to an hour, depending on that particular doctor's procedure. Within a few weeks, that doctor will issue an IME report that will be circulated to the attorneys and yourself for review.How long does it take to get an IME report back in Illinois? ›
How Long Does It Take to Get an IME Report? Typically, your attorney might expect to receive the IME report within a few weeks after the examination. However, the timeframe may vary depending on the complexity of your case and the doctor's schedule.What are the components of an IME? ›
The IME is typically a one-time interview, physical examination, and supplemental record review performed by an impartial (ie, nontreating) physician at the request of a claimant's legal counsel or opposing defense attorney, in order to provide focused answers to a particular set of questions intended to help resolve a ...What is the difference between detailed patient examination and comprehensive patient examination? ›
Detailed – an extended examination of the affected body area(s) and other symptomatic or related organ system(s). Comprehensive – a general multi-system examination or complete examination of a single organ system.What is the difference between IME and IMR? ›
Often confused with peer or independent medical reviews (IMR), an IME is utilized for a second opinion, often after a peer review has already occurred. A key difference between IME and IMR is independent medical review does not involve an in-person examination of the patient.How long does it take to get a settlement check in PA? ›
What Happens if My Injury Settlement is Delayed in Pennsylvania? In most cases, once everything is settled, you should receive your money within six weeks. However, in some situations, the payment is delayed.How long does an insurance adjuster have to respond in Pennsylvania? ›
After you file your claim forms and the insurance adjuster has made an inspection of the damage, your insurance company usually will respond in writing within a week. By law, the company must respond in writing within 15 business days advising you if your claim has been accepted or rejected.What is an impairment rating evaluation in Pennsylvania? ›
What is an Impairment Rating Evaluation (IRE)? An Impairment Rating Evaluation is a medical examination that an Employer is entitled to have an employee attend if that employee has received 104 weeks (2 years) of workers' compensation disability benefits.
The term “IME” is an acronym for “Independent Medical Exam.” That said, there really is not such a thing as a truly “Independent” medical exam. These exams are not typically ordered by some independent neutral. The doctor chosen to do the exam is not handpicked to be fair by a judge.How long does an insurance company have to investigate a claim in Illinois? ›
21 working days – an insurer must conduct a “prompt investigation,” which applies to all activities of the insured related directly or indirectly to the determination of liability based on claims under the coverage afforded by the policy and shall be evidenced by a bona fide effort to communicate with all insureds and ...What is Section 12 of the IME in Illinois? ›
As established in Section 12 of the Illinois Workers' Compensation Act, employers or their insurance companies may use an Independent Medical Examination (“IME”) to assess details surrounding the employee's claim, including the nature and extent of their alleged work-related injury and the expected duration of ...What is the purpose of the IME? ›
An independent medical examination (IME) is a medical evaluation performed by a medical professional on a patient who was not previously involved in the treatment of that patient, to evaluate the patient's course of prior treatment and current condition.What are the 3 contributing factors that determine the level of EM service? ›
- Medical decision making (MDM) The next three elements are called contributory factors. ...
- Coordination of care.
- Nature of presenting problem. There is one final component for E/M services, which you may use to determine the appropriate code level.
An independent medical examination is a medical or psychiatric evaluation to determine the current status of an employee's medical condition or to determine whether the condition is related to employment.What is the difference between peer review and IME? ›
The medical opinion in an IME is drawn from direct examination and objective testing of the patient while in a peer review, the clinical inferences are made by reviewing the information in the medical records, and the data provided by other healthcare providers and collateral information.How long does it take to get an IME report back in NY? ›
Be frank with both the IME doctor and your personal doctor about your activities of daily living. Also, let the IME doctor know of any side effects of your medications. What occurs after the exam? The IME exam generates a report that is sent to all parties, generally within 10 days.What does IME report stand for? ›
An independent medical examination (IME) is a medical evaluation performed by a medical professional on a patient who was not previously involved in the treatment of that patient, to evaluate the patient's course of prior treatment and current condition.