Disability insurance companies generally depend on either an Independent Medical Exam (IME) or an External Medical File Review without examination to reject a long-term disability claim. In contrast to an IME exam, where a disability claimant is checked by a doctor, disability insurance companies typically employ outside doctors to study your case and provide views about your physical abilities without ever physically inspecting the claimant. This process is termed External Medical File Review. 

Rejecting disability claims: 

The disability insurance provider will analyze your medical records to assess your degree of disability with their in-house nurse or doctor (or a third-party organization). Moreover, the insurance company would never approve a disability claim if the claimant had never undergone a physical examination by a physician, given that they typically deny claims based solely on their paper review of your file. This “paper review” can be frustrating and reveals a double standard in the evaluation of disability claims. 

You must ensure the claim is as thorough, comprehensive, and unchallengeable as possible to move past this step. Your medical records must not contain errors or discrepancies that provide the insurance company with a reason to reject your claim.

Be informed about the Independent Medical Exam:

The insurance provider may request that you take an independent medical examination or evaluation if it finds fault with the information in your claim file. To assess if you still fulfill the policy’s definition of “disability,” the disability insurance carrier will enter into a contract with a third-party vendor, who will perform an evaluation.

Before consenting to see the doctor the insurance company has recommended, it’s necessary to conduct some inquiry. If you look up this doctor and discover that they solely provide medical reviews rather than seeing their own patients, this may be a telltale sign that they are working for the insurance company. You can ask to be evaluated by a different doctor in these circumstances who would be less inclined to the insurance provider.

Although some IMEs do result in favorable outcomes for the client, it’s crucial to approach this procedure with a degree of caution. You should also not be hesitant to ask for a new doctor or contest the conclusions in the IME report.

Final thoughts:

If you want your application for long-term disability benefits to be approved, how you handle the paper claim review and the IME may well be vital. Having legal representation throughout the process can assist ensure that your claim file is in order and that the insurance company won’t be able to use any loopholes to reject your claim.