What are Independent Medical Examinations (IMEs) in Long-Term Disability Claims?

When it comes to long-term disability (LTD) claims in Canada, the process can often feel overwhelming for those seeking support. One component that can influence the outcome of an LTD claim is an Independent Medical Examination (IME). Understanding what IMEs entail, their purpose in the claims process, and how they can impact the outcome of your disability claim can be essential for receiving your benefits.

At Preszler Injury Lawyers, our experienced long-term disability lawyers are dedicated to helping clients receive the benefits they are entitled to for their injuries or illnesses. Whether you are in the midst of the claims process or your benefits have been denied, we’re here to help. Serving all of Canada, we can assist you no matter where you’re located. If you’ve been asked to partake in an IME by your insurance company and have questions about your legal rights, contact our disability lawyers online at 1-844-791-8202 today.

What is an Independent Medical Examination?

 An Independent Medical Examination (IME) is a comprehensive medical evaluation performed by a third-party physician or doctor who is not already involved in a claimant’s ongoing treatment. Normally, this will be a healthcare professional of your insurance company’s choosing. The purpose of an IME is to provide an impartial medical opinion on your condition. The findings of an IME can be critical for insurance companies when making decisions about the outcome of your long-term disability claim.

IMEs are usually requested by insurance providers to verify the legitimacy of your claim and to evaluate whether you meet the criteria for LTD benefits. As a result, IME reports can be used by:

• Insurers, to confirm or deny benefits.
• Employers, to assess your disability status and necessary accommodations.
• Legal professionals, to quantify damages in a settlement or mediation.

The main purposes of an IME are to:

• Validate the level of disability, impairment, or limitations incurred from the incident you are claiming benefits for.
• Provide treatment recommendations (if necessary) to help you recover.
• Determine liability, causality, and future health risks.

Often, LTD policies will provide for the right of the insurance company to request an IME. Although you may refuse to participate in an IME, your benefits may be denied or your claim may be dismissed as a result. For this reason, it’s important to understand the purpose of IMEs and what to expect when they are requested.

The IME Process: What to Expect

During an IME, you will be assessed to determine whether you still meet the insurance company’s definition of ‘disabled’. Preparing for an IME can alleviate some anxiety during the process. You can do so by:

• Gathering Medical Records: Compile all relevant medical records, including notes from healthcare providers, treatment plans, and any previous assessments. This information can be useful for both yourself and the examining physician.
• Reviewing Your Claim Details: Understanding the specifics of your claim, including the conditions you are claiming for and the criteria set out by the insurance provider, can help clarify expectations during the examination.
• Understanding the Exam Format: The IME will generally involve a physical examination, a review of your medical history, and potentially a series of questions about your daily life and functional abilities.

It is recommended that you take notes during the IME, including the doctor’s name, what was discussed, and the questions asked. You should also consider requesting a copy of the IME report, as it may conflict with your own doctors’ assessments.

Disputing IME Findings & Claim Denials

The findings of an IME can significantly affect the outcome of your long-term disability claim. In some cases, insurance companies will use an IME report to deny or revoke your benefits. This can occur when the IME indicates that you are capable of returning to work or do not meet your insurance company’s criteria for ‘total disability’.

If your benefits are denied, there are actions you can take to dispute the decision. You may want to consider:

• Obtaining an Alternative Opinion: Claimants can seek an independent evaluation from another third-party physician to provide a contrasting opinion.
• Requesting a Review: If you have legitimate concerns about the IME’s findings, you may request a formal review of the decision made by the insurance company.
• Seeking Legal Counsel: A long-term disability lawyer who has experience with long-term disability claims can provide valuable guidance through this process

Do You Have Questions About Independent Medical Examinations and Your Rights? Talk to Our Long-Term Disability Lawyers Today

Independent medical examinations play a significant role in the long-term disability claims process in Canada. Understanding what to expect during an IME, how it can impact your claim, and the steps you can take to prepare for it are vital for navigating the process. By staying informed and proactive, you can better pursue the compensation you deserve for your injury, illness, or disability.

At Preszler Injury Lawyers, our long-term disability lawyers are committed to helping you navigate disability claims every step of the way. To schedule a FREE consultation with our legal team, contact us online or call 1-844-791-8202 today.