UNUM’s Dirty Tricks: How to Beat an IME
Let’s be clear: there is nothing “independent” about UNUM’s medical examinations. The disability insurer works closely with a network of doctors and medical providers whose primary goal is building cases against you and other UNUM claimants. If an insurance adjuster schedules you for an IME (independent medical examination), you need to be prepared.
However, you can beat a UNUM IME. As part of our UNUM series, Bryant Legal Group outlines the IME process, discusses some IME doctor tricks, and explains how you can protect your long-term disability claim from a damaging IME report.
What Is an “Independent Medical Examination?”
Most long-term disability plans say the adjuster can send you to an occasional IME. Insurance adjusters order IMEs for many reasons:
- You haven’t seen a doctor or a specialist in a while, and they want an updated psychological evaluation or physical examination
- There’s evidence that suggests your condition has changed or improved
- They’ve noted “red flags” in your claim
- They’re looking for a reason to deny your claim
While UNUM will assure you that the IME doctor is completely neutral, this is rarely the case. Most IME doctors don’t treat patients. Instead, these doctors make their living performing IMEs for insurance companies, who provide generous compensation for one-time examinations. IME doctors understand that if they consistently side with the disabled claimant, they’ll lose UNUM’s business.
Do I Have to Go to UNUM’s Medical Examination?
If UNUM’s insurance adjuster schedules an IME, you typically must attend the appointment. If you have a serious conflict, like a scheduled surgery, call your long-term disability lawyer; they may be able to reschedule your examination. However, if you refuse to attend the IME, you could lose your right to long-term disability benefits.
What to Expect During a UNUM IME
IME doctors vary in their approach. While some physicians perform very detailed, lengthy exams, most IMEs are relatively short. However, most IMEs follow a relatively similar format:
- When you check in to the doctor’s office, they may ask you to sign a series of forms. If they want you to sign a medical authorization (HIPAA) form, politely decline.
- The doctor or nurse will ask you some questions about your medical history, symptoms, and lifestyle.
- The doctor will perform an examination, which may take a matter of minutes or hours.
- Sometimes, the doctor will order diagnostic testing, like an x-ray, nerve conduction study, or pulmonary function test.
- The doctor will thank you for your time and walk you out to the waiting room.
After your examination, the IME doctor will send a written report to UNUM that discusses your medical conditions, outlines their clinical findings and opinions, and explains your degree of disability. You typically will not get a copy of this report unless you receive a denial of benefits and file an appeal. However, UNUM’s IME reports tend to favor the insurance company and suggest that you’re malingering.
What’s Malingering and Why Does It Matter?
Insurance companies are always trying to damage claimants’ credibility. When a doctor says there’s evidence of malingering, they are implying that you’re exaggerating your symptoms for financial gain. In short, they’re saying you’re a liar.
However, there isn’t a test that objectively proves that someone is exaggerating their symptoms. Waddell’s signs, which are often used to identify “malingering” in orthopedic cases, are really a tool that helps determine when psychological and emotional issues are impacting someone’s recovery.
Don’t get upset if UNUM or their doctors suggest you’re malingering. It’s one (very biased) doctor’s opinion. And, your lawyer may be able to build a case that proves otherwise.
5 Ways You Can Beat a UNUM IME Report
Even if UNUM denies your case based on an IME report, you can fight back. However, there are a few ways you can strengthen your claim from the very beginning.
1. Don’t Exaggerate Your Symptoms
As we mentioned above, UNUM’s IME doctors love to report malingering. If you exaggerate your symptoms during the exam, they will notice and report it. Instead, do your best and give an honest description of any pain you experience during the exam.
Similarly, you should answer the doctor’s questions honestly and respectfully, but only answer the questions you’re asked. For example, if the doctor asks you how far you can sit, answer the question — you don’t need to get into the details about how you suffered through a long flight to visit your sister.
2. Build Strong Relationships With Your Treating Doctors
When claims adjusters and judges review your long-term disability claim, they should consider all the evidence, not just a single IME report. Medical records are essential to every long-term disability claim. These reports can help establish the severity of your condition, your abilities, and the steps you’ve taken to get better.
When you see your doctors consistently and give complete and accurate information about your medical issues, the resulting records may counteract a report from a one-time examination. Your lawyer can also help strengthen your claim by consulting with their own medical experts and getting detailed statements from your treating physicians.
For example, suppose UNUM’s IME doctor reports evidence of malingering and suggests that you’re “drug-seeking.” However, your medical records show you’ve never gone to an emergency room to demand narcotics, and your doctors’ records and testimony verify that your pain complaints are consistent with their examinations and your MRI films. No one, other than a UNUM representative, is going to buy the IME doctor’s false allegations of malingering.
3. Assume You’re Under Surveillance Before and After an IME
UNUM loves surveillance. The insurance company frequently hires private investigators to track you before and after an independent medical examination. When they order this surveillance, they are hoping that your day-to-day routine will be inconsistent with your conduct and behavior at the IME doctor’s office.
Similarly, the IME doctor’s staff will probably watch you enter and exit the building. It’s not uncommon to see IME reports where the doctor implies that your gait and pain behaviors changed as soon as you entered or exited his building.
While you can’t stop a dishonest IME doctor from making false or unfair statements, it’s important that you act honestly and consistently before, during, and after your IME.
4. Bring a Trustworthy Witness With You
You have the right to bring a witness to your IME. We often suggest that our clients bring a trusted and reliable family member or loved one with them. That way, if the doctor makes false claims in their report, you’ll have another corroborating witness.
Ask your witness to sit quietly in the examination room and take notes, focusing on the following issues:
- The time the examination starts and finishes
- Any statements the IME physician makes about your condition or abilities
- What activities the doctor asks you to do
- Whether you report any difficulty or discomfort to the insurance company’s doctor
- Anything that seems important or unusual about the examination
The person you bring doesn’t need to interact or participate in the examination at all. You also may be able to videotape the exam, but you should ask your lawyer beforehand.
5. Consult an Experienced Disability Insurance Lawyer
When UNUM schedules an independent medical examination, they’re getting ready to fight. So, it’s a good idea to start preparing your case for an appeal. When you consult with a long-term disability lawyer before an IME, they can help you fully prepare for the examination. They may even be familiar with the physician you’re seeing and can give knowledgeable advice about the IME doctor’s tricks and tactics.
Bryant Legal Group: Fighting for People With Disabilities
At Bryant Legal Group, we help people across Illinois with their UNUM long-term disability claims. If you have questions about an IME or your disability insurance claim, contact us today. To schedule your free initial consultation with an experienced disability attorney from our team, call us at 312-561-3010 or use our online contact form.
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.