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Battle of the Doctors: Their IMR vs. Your Treating Doctors

by | Aug 18, 2022 | Firm News

Insurance companies are for-profit institutions. As such, they don’t always automatically accept a claim for disability payments. They can put up a variety of roadblocks, one of which is termed an Independent Medical Review (IMR) by a team of physicians on the insurer’s payroll who review the documentation you submit to support your long-term disability claim. Being on the insurer’s payroll, they will most often find some deficiency in your claim to deny it. If this happens to you, what are your options?

If you’re submitting an LTD insurance claim in or around Minneapolis, Minnesota, contact the long-term disability attorneys at Beedem Law. We will be happy to review your case and help you navigate the system to pursue the benefits you deserve, both on initial filing and on appeal, if necessary. We will fight for you every step of the way.

Beedem Law also proudly helps clients in St. Paul and Duluth, and in the counties of Hennepin, Ramsey, Dakota, Anoka, and the rest of Minnesota.

What Is an Independent Medical Review (IMR)?

When you submit a claim under your LTD policy, you must submit your doctor’s evaluation along with other medical evidence, including test results such as X-Rays, MRIs, and others. The insurance company will then evaluate your submitted claim and accompanying documentation. To do this, they often resort to what is called an Independent Medical Review. These are paper reviews that only review the medical records and other information sent to their doctor by the insurer.

Most insurance companies rely on their IMR reports over the treating doctor’s evaluation. Most IMR providers are making a fair amount of money doing these for insurance companies. In fact, many are on the insurer’s payroll as employees.

Most IMRs are not going to support disability no matter what your treating doctor says, or how many doctors you have supporting your disability. IMRs look for any inconsistency in your medical records to claim that you are not disabled.

Can You Appeal an Adverse IMR Decision?

Appeals are always available but they are governed by different rules if your policy was company-sponsored or purchased on your own from an insurance broker. Employer-sponsored LTD policies are governed by the federal Employee Retirement Income Security Act (ERISA).

Though the title sounds employee friendly, ERISA actually contains favorable provisions for the insurance company, including the provision that you are not allowed to submit additional evidence if the case goes to trial.

Private insurance LTD policies are governed by state law and the provisions set forth in the insurer’s policy. You will need to follow their governing provisions and timelines when appealing. Your case can still end up in court, but you need to read the fine print of the policy to ascertain your full rights. This is where an experienced attorney is absolutely essential.

Difference from an Independent Medical Exam (IME)

An independent medical examination (IME) may be ordered by your insurer at some point after you’re cleared (or not) for benefits. This requires you to undergo an actual physical exam chosen by the insurance company from physicians and medical groups allied with the insurance company. If you refuse the IME, your benefits can be denied or canceled. Even if you agree, the odds will no doubt be stacked against you.

The Comprehensive Guidance You Need

When you’re filing for an LTD policy claim, remember that the insurance company underwriting the policy will use every effort and trick of the trade to deny your claim. Many policyholders simply assume that filling out the claims form provided by the insurer will lead to a favorable result. Instead, it will often lead to various questions, challenges, and an Independent Medical Review that may result in a denial of your claim.

At Beedem Law, our long-term disability attorneys can help you assemble the medical evidence and professional testimony necessary to put the odds of approval in your favor. Contact us immediately for a consultation if you’re in or around Minneapolis, Minnesota, or in Duluth or St. Paul. We’re proud to serve all of Minnesota, including the counties of Hennepin, Ramsey, Dakota, and Anoka.