Total and Permanent Disability (TPD)
What role do independent medical examinations play in TPD claims?
Category: Claims
Independent Medical Examinations (IMEs) are commonly used by insurers during TPD claim assessments and can significantly impact claim outcomes. When you submit a TPD claim, insurers often arrange for you to be examined by a doctor they select - this is the 'independent' medical examiner, though this term is controversial as insurers pay these doctors and use them repeatedly. IMEs serve to verify your medical condition, assess the permanence of disability, evaluate whether you meet the policy's TPD definition, and potentially contradict evidence from your treating doctors. You're typically required by policy terms to attend IMEs, and refusing without good reason can result in claim denial. However, IMEs are often criticized because insurers tend to use the same doctors repeatedly (raising independence questions), IME doctors often have brief examinations compared to your treating doctors' ongoing relationship, and IME reports frequently favor insurers, finding claimants less disabled than treating doctors report. To protect yourself during IMEs, take a support person to take notes, record how the examination was conducted, request copies of all reports generated, ensure the examiner has complete medical history, and don't downplay your limitations but be honest. If an IME report contradicts your treating specialists, your doctors can respond with supplementary reports addressing the IME's findings. IME reports are evidence but not automatically conclusive - decision-makers must consider all evidence including treating doctor opinions.
Related Topics:
tpdclaimpolicyinsurerdisabilitymedical history
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