Disability Insurers Misuse Independent Medical ExaminationJune 19, 2012 | Insurance News
In 2005, the California Insurance Commissioner fined Unum $8 million and ordered it to stop engaging in unfair business practices. The California Order specifically prohibits Unum from engaging in 28 activities. In the next few blog posts, we will take a closer look at some of the more important prohibitions from this list.
The third prohibition in the California Order forbids Unum from selectively using independent medical examination (IME) information to its exclusive benefit. The purpose of an IME is for an independent doctor to examine a disability claimant to see whether or not he is actually disabled. Supposedly, the IME doctor performs the IME objectively, without bias. Unfortunately, though, several factors indicate that these evaluations are not being conducted fairly.
Here are a few reasons why: First, the disability insurer chooses and pays the IME doctor; the claimant almost never gets any input on which doctor to see. This enables the disability insurer to seek and hire IME doctors who will write favorable reports, i.e., stating the disabled claimant can go back to work. Typically, once the disability insurer finds an IME doctor who writes favorable reports, the disability insurer will continue using this physician over and over again to ensure satisfactory outcomes. The disability insurance company also controls what information the IME doctor reviews before the doctor examines the claimant. This allows the disability insurer to selectively present information that supports its position, and only its position, that the claimant is not disabled. Even an unbiased physician might have difficulty performing a fair IME if the data he is looking at is distorted or inaccurate.
Despite the California prohibition, Unum and other disability insurance companies continue misusing information gathered during IMEs to deny disability claims. The good news is these biased IMEs can be detected today. With help from an experienced disability insurance lawyer, you can ensure that the insurer gives you proper consideration for disability benefits.