The answer to that is simply yes, insurance companies can hire a doctor to say whatever the insurance company wants that doctor to say so they don’t have to pay your disability benefits. Is that fair? No. Can they do it? Yes, unfortunately.
Beyond that, they can even require that you go see their doctor to be physically examined by their doctor before they make a decision about whether to approve your benefits or not. That doctor then can turn around and say that he or she has physically examined you and that you are able to perform the main duties of your occupation. It is not fair.
What can you do in response to that?
What to do?
There are a couple of things that you can do in response to that. The first thing is, make sure that you go see your doctor for a full examination around the same time as you see the insurance company’s doctor so that we can compare and contrast the differences in the examination. See, the IME, or the “independent doctor” who’s being paid by the insurance company, so he’s not really independent, will say certain things about a physical examination of you. And then if you compare that to what your doctor says, there is a discrepancy. Let’s say one doctor says you’ve got a 90-degree range of motion and another doctor says you’ve only got a 25-degree range of motion. That’s a big difference, right?
So based on those observations, it’ll help the court, later on, see the discrepancies between the doctors and your treating physician doctor. Usually, treating physicians are given more weight in their evaluation because they’re not just getting paid by the insurance company, they’re getting paid by you. They are ongoing treats with you and their goal is to help you get better, not to write an opinion. So, that’s one thing that you can do.
The next thing that you can do is you can take a copy of the report from that IME doctor and give it to your treating doctor and ask him or her for a review or an evaluation of that treating doctor’s opinion.
There has been some success with this particular aspect because a lot of times when a non-treating doctor writes an opinion that says you’re fine, you can go back to work, the treating doctors take exception to that and they get ticked off, quite frankly, because their opinion is no longer valued. The record review doctor, the IME doctor, doesn’t give any credence to what the treating doctor says, and the treating doctors often get ticked off about that.
If you ask the treating doctor for their opinion based on what the IME doctor says, a lot of times, you get a lot of good information, much more than you would get in just having the medical records sent to the insurance company.
Once you get that information, it’s a lot easier to craft an argument on your behalf to say that you are disabled and that the IME doctor or the record review doctor hired by the insurance company is not telling the truth, or not fully considering all the facts, or not fully considering all of your symptoms and all the medical objective, medical information out there.
If you have questions about an IME doctor or a record review doctor, or if your claim has been denied, reach out to us, we’d love to review your denial letter. We do that for free, and we will make sure that you have a plan, a path, a well-defined path going forward so that you know what to do to win your disability appeal.
