Independent Medical Exam Recommendations Not Always Followed

When it comes to an independent medical exam, long term disability insurance companies have been known not to follow the recommendations of your doctors as reported in your disability claim. They may even order you to an independent medical exam (“IME”) or functional capacity evaluation (“FCE”) with a doctor of their choosing. That doctor will then submit a report to the company giving their opinion on your disability.

These types of exams are controversial because they are being conducted by someone who is being paid by the insurance company. There is a level of bias that is presumed. But what happens when even their own doctor’s evaluation is ignored?

The Courts have repeatedly held that an insurance company’s failure to follow the recommendation of their own doctor is unreasonable. The cases that have been before the court are ones where the claim should have been approved and benefits paid, but the insurance company denies the claim. The courts noted the insurance company should, at a minimum, follow the recommendation of the doctor they pay to evaluate your disability. It has even been found unreasonable for the insurance company to ignore the recommendation of their reviewers to conduct an IME or FCE. This type of behavior by these insurance companies shows that they are only concerned with the finances of your disability claim. They are not interested in getting all the facts to make a proper decision.

There are many issues that can come up with independent medical exams and FCE’s. This is just another example of how they can complicate or delay a disability claim. Having an experienced attorney handle your disability claim can reduce the chance of unnecessary complications, especially with IME’s or FCE’s. Contact the law office of Dabdoub Law Firm for an evaluation of your case and see how our experienced attorneys can help.

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