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Why Isn’t My Insurance Company Sending Me for an Independent Medical Exam?

When you file a short or long-term disability claim, your insurance company may send you to an independent medical exam. Even though you have already submitted documentation from your doctor documenting your disability, the insurance company may want their own medical exam.

Except sometimes, they don’t and that can be concerning. Are they going to deny your claim without further medical testing? Or do they trust the evidence you’ve provided? It could be either.

What Is an Independent Medical Exam

An independent medical exam is a tool that insurance companies may request when reviewing your disability claim. These exams should be conducted by third-party, unbiased doctors but most are done by physicians who regularly work for the insurance company. This means that the doctors doing an independent medical exam may be looking for a reason to give the insurance company so they can deny your claim.

That’s the biggest reason an insurance company would request you undergo an independent medical exam—they want some medical opinion to deny your claim. They may also request it because they simply want a second opinion to document your disability is of a sufficient level that you require benefits under your plan.

Reasons Your Insurance Company Might Not Request an Independent Medical Exam

Now that we know what an independent medical exam is, let’s look at why your disability insurance company might not request you get one. It’s not always a bad thing if your insurance company doesn’t order one, as it could mean your disability is so clear that they have approved your claim.

You Provided Sufficient Evidence

Submitting a disability claim can seem overwhelming. Your insurance company will request lots of medical, vocational and occupational documentation showing that you have a legitimate disability. If you fail to provide everything they ask for, they may simply deny your claim for that reason. Even the Social Security Administration has high denial rates, in part for the same reason.

You may have submitted exactly what the insurance company needed and still been denied. If you did, their medical reviewer may have minimized, normalized, routinized then capitalized on the exam to deny you benefits.

Your Doctor’s Chart Notes and Records Make a Compelling Case

When you submit evidence of your disability to your insurance company, some of the documentation you submit will include your doctor’s chart notes, medical records testing and medication. If your doctor has kept meticulous and detailed notes regarding your restrictions and limitations, the insurance company may not need any additional evidence of your disability.

Your doctor may also be able to provide you with additional documentation that renders a compelling opinion about your disability. While factual evidence usually makes a more compelling case, subjective evidence based on your doctor’s experience can provide great insight into your disability, making it less likely that the insurance company will request an independent medical exam.

You Submitted Objective Medical Evidence

Objective, verifiable medical evidence is based on fact. This might include lab results, MRIs, CT scans, and other imaging tests.

Objective medical evidence is powerful because it is nearly indisputable. If you have a fracture, for example, an X-ray will show your broken bone. Then an insurance company could not easily suggest that you don’t really have a disabling fracture. By submitting objective evidence, you can make it more likely that your insurance company will avoid demanding an independent medical exam.

The Insurance Company Doesn’t Want the Litigation Costs

When you submit powerful subjective and objective evidence, your insurance company may simply avoid the time and expense of requesting an independent medical exam. These exams are costly and, if the insurance company realizes you have a legitimate claim, and you have received the most appropriate care for your condition, they may think it won’t do any good to get a second opinion.

Insurance companies make staggering amounts of money. They do that in part by not paying out as many claims as possible. They’re also making strategic business and claim decisions. If they know your claim will prevail, they would rather save the time and expense of sending you to an independent medical exam and simply negotiate a settlement.

Your Doctor Is Highly Educated and Respected

While all physicians must have a certain amount of education and experience, some doctors are better known, and more respected and feared by insurance companies than others. If your doctor is a specialist in your area of disability or is well known for objective diagnoses, that could encourage the insurance company to not send you for an independent medical exam.

When your doctor has a certain level of integrity and respect, the insurance company may yield to their expertise and simply take your doctor’s word about your disability. Again, insurance companies want to avoid paying out your claim, but they also should carefully analyze the situation.

If an independent medical exam will not change your diagnosis, or the restrictions and limitations then the insurance company may not send you to one.

You Are Not on Social Media

This is one of the most troublesome issues for people who file a disability claim. In today’s world, many people post minute details about their personal lives. That includes pictures and videos of their activities.

If you’re claiming a disability but posting videos of you playing golf or tennis, for example, that might be a problem for your disability claim. Insurance companies have teams of investigators scouring your social media accounts to find similar information that can help them have support to deny your claim. If, however, you’re not on social media or you don’t post items that could cause the insurance company to question your disability, then they may be less likely to send you to an independent medical exam.

Speak With a Top-rated Experienced Long-term Disability Insurance Lawyer Today

Insurance companies are notorious for denying even legitimate claims, so they don’t have to pay out monthly or lifetime disability benefits. Your best course of action is to partner with an experienced disability insurance lawyer who can help you navigate the complexities of filing your claim and ensuring you continue to get the benefits you deserve.

DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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