Preparing for an IME in Ontario LTD Claims: What to Expect and How to Respond

Over the past two years, as you were going through what has seemed like an endless series of medical exams, interviews, and therapy sessions, you have been holding on to the hope that all those medical professionals would be able to find a way to “put you back together”. Meanwhile, while understanding that your former very active lifestyle — along with your former earning power — are things of the past, you have done your best to survive financially with the help of your disability insurance benefits.

When you questioned the letter you received from the insurance company notifying you that your benefits are in danger of being terminated at the 24-month mark, you were told that you can agree to undergo an IME, or Independent Medical Examination. You’re not sure why this is necessary, given the nonstop exams and therapy sessions you’ve already had, but you cannot afford to lose your benefits. What is this really all about? What should you expect? How should you prepare?

Quick Answer: How do I prepare for an IME in an Ontario LTD claim?

An IME is an insurer-scheduled assessment to evaluate your functional limits for work. Prepare by reviewing your medical records, practicing a clear “typical day” description, and bringing key documents and assistive devices. During the IME, be honest, consistent, and ask for breaks. Afterward, request the report quickly and respond to any errors with medical and vocational evidence.

What is an IME in an Ontario LTD claim, and why did I get one?

What is an Independent Medical Examination (IME)?

An IME (Independent Medical Examination) is conducted by doctors and therapists chosen by the insurance company to evaluate your condition and decide if the treatments recommended by your own doctors are necessary and appropriate.

But why now, you wonder? After two years of treatments and therapies, why only now is it important to check if those recommendations were the “right ones”?

The real purpose of the IME

The answer to “why now?” lies in the fact that your  Ontario, Canada LTD policy contains a definition of disability, listing in detail what conditions must exist for you to collect the benefit.

Whereas, up until now, you have been eligible for benefits because you have been unable to perform the duties of your own occupation, starting from the 24-month mark, you will be entitled to receive benefits only if it is proven that you are unable to work at any occupation for which you qualify based on your level of education, training, and work experience.

Whereas IME results can be used to provide a neutral, unbiased assessment of medical facts, those results can also be used to justify denial of benefits. It’s important for you to understand one hard truth: It is generally not in the best interest of any insurance company to help you. While this cannot be proven, insurers, in looking to deny or to terminate LTD benefit payments, seek to find a medical justification (from doctors they hire) for denying or reducing benefit payments to an insured.

Investigators hired by an insurer may have uncovered some long-past medical appointment or recommendation that was not included in the paperwork you submitted and may attempt to confront you with that during the IME.

What steps should I take in preparing for an Independent Medical Examination in Ontario?  

1. Gather and organize your file of documents.

• Your insurance policy
• Prior approvals of benefits
• All medical records and appointments
• Description of the latest job you had and the job duties involved

2. Practice your description of a “typical day”.

The IME doctor will be asking you to describe your daily life and the impact that your injury or illness has had on your everyday ability to function. What everyday household tasks are you able to perform?  Errands? Social activities? Prepare to be truthful and consistent, and to avoid exaggerating your limitations.

3.    Check your social media “hygiene”.

Review all your own social media exchanges, including comments and photos, making sure those cannot be interpreted to mean you are less “disabled” than you have claimed.  In the IME interview itself, don’t hide anything – prepare to be open and honest.

4. Gear up mentally. Get enough sleep the night  before. Think positive.

Give yourself a lot of credit. Your life was upended, yet you’ve survived  two+ years,  working with your doctors and therapists to regain function and physical and mental strength. If these IME examiner think there’s even more that can be done to restore your abilities — bring it on!   

5. Consult with your Ontario LTD lawyer.

Going over the IME notice with your Ontario Long-Term Disability lawyer can help you understand the specific conditions of the examination as described in that notice. Do the specific testing areas planned appear appropriate given your medical history?

Are there other tests and evaluations I may be asked to take?

The IME itself actually has two purposes:

1. Testing the diagnosis of your illness or the extent of your injuries, exploring the extent of any chronic pain you’re experiencing, your cognitive abilities, and any neurological damage you’ve suffered.
2. Testing your functional capacity in order to define what levels and categories of work you are capable of performing.

For this second purpose, there are several other tests and evaluations that may be requested or recommended by the LTD insurance company, including:

• FCL (Functional Capacity Limitations) – tests the impact your condition has on your ability to work
• FCE (Functional Capacity Evaluation) – tests your ability to perform repetitive physical actions
• TSA (Transferable Skills Analysis) – judges whether your training and experience qualify you for any gainful employment
• Competitive Employability Assessment – judges whether employer s will want to hire you in your now diminished capacity