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Asked to submit to an independent medical assessment? Here’s what you need to know

Montreal doctors say Quebec government still ignoring their concerns about allocation of family physicians.  (Getty Images/File).
Montreal doctors say Quebec government still ignoring their concerns about allocation of family physicians. (Getty Images/File). Getty Images

Many individuals receiving long-term disability benefits will at some point be asked by their insurance provider to submit to an independent medical assessment or examination (IME).

An IME is meant to be an objective, third-party medical examination, conducted to determine whether the individual getting benefits is disabled and cannot work. If the insurance company determines that you are able to work, they will move to cut off your long-term disability benefits.

These assessments are not done by your own medical team. Instead, the insurance company selects and pays the assessor. So it’s not surprising that many disabled claimants have a valid degree of skepticism about the process.

As disability lawyers, we are regularly asked by disabled claimants whether they need to attend an IME if an insurance company requests one.

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Most insurance policies are drafted to favour the insurance company and include provisions that require a disabled claimant to submit to an independent medical assessment if asked. This means that as a disabled claimant, you are required to cooperate with the insurer to arrange and attend the IME.

READ MORE: Long-term disability claim denied? This is why you need a disability lawyer

In some instances, the insurer will make travel arrangements to and from the assessment for you.

The IME itself can take different forms depending on the nature of the assessment. For example, some physical assessments, also called functional ability evaluations or functional capacity evaluations, occur over two days. Some assessors prefer to have a brief interview on one day and a fuller assessment, with an examination and testing, on a second day.

Although you have a duty to cooperate and submit to an evaluation, there are some steps you should take when an IME occurs.

Here are some tips from my practice as a disability lawyer on how to handle an IME and properly prepare for a potential move by your insurer to end your disability claim.

Make a record of the IME for yourself

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Record how long the assessment took, what happened during the assessment, what was asked of you, what you said, and how you felt during and after — even the next day.

Your experience could be significant if you need to rebut the assumption that your capabilities, when observed over several hours, are indicative of a capacity to sustain work day in and day out.

Ask for a copy of the IME report

After the assessment, ask for a copy of the report from your case manager or insurance adjuster. You will not automatically get a copy, and some insurers may even refuse to give you a copy directly.

Instead, the insurer might say they will provide a copy to your treating doctors. Make sure this is done, so you can then get a copy from your own medical team.

Go through the IME report yourself and take notes

Look for inaccuracies in your review. Read carefully and watch for any inaccuracies on your medical history, what you reported to the assessor or even what happened during the assessment. Give this list of inaccuracies to your case manager or insurance adjuster.

READ MORE: What to know about your long-term disability rights in the age of COVID-19

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Get a rebuttal report

If the conclusions of the IME are not favourable — in other words, if it says you are not totally disabled and can work — then give the report to your own medical team to provide their comments.

Your primary treating doctor or specialist can prepare a report or letter responding to the IME results, stating again that you are totally disabled and cannot work. You can then present this to the insurer to attempt to resist their declining your disability benefits.

Contact a long-term disability lawyer

Often the true goal of an insurer’s requesting an IME is to form a basis to undermine legitimate disability claims. If you are asked to attend an IME, you should know that it could contradict what you and your medical team are saying about your health, your functional limitations and your inability to work.

An IME may comment on treatments you should undergo or medications you should take. This way the insurer can rely on the terms and conditions of the disability policy to justify cutting off your benefits. If you don’t try the treatments or medications, they can argue that you are refusing to take the necessary steps to treat your disability and decline to pay.

If this happens, contact my team at Samfiru Tumarkin LLP with your questions about the process and your rights.

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Has your long-term disability claim been denied? Is the insurance company threatening to cut off your payments after conducting an independent medical assessment?

Contact the firm or call 1-855-821-5900 to secure assistance from a disability lawyer in Ontario or British Columbia. Get the advice you need — and the compensation you deserve.

Tamar Agopian is a disability lawyer and senior associate at Samfiru Tumarkin LLP, one of Canada’s leading law firms specializing in disability claims and employment law.