Many of our clients in San Francisco, San Jose, and all over the East Bay with ERISA-governed long term disability policies ask their attorney whether they must comply with an insurance company’s request to attend an “independent” medical examination (an “IME”). The answer often turns on what the disability plan document requires. Most of the policies our attorneys see include provisions that require a claimant to submit to an evaluation by a doctor the insurance company chooses. If the policy requires submission to an IME, we usually advise our clients to not unreasonably refuse to be examined. This is because a refusal to be evaluated could result in the termination of disability benefits.
A case in point is a recent court decision in the matter of Lee v. ING GROEP, N.V., et al., No. 14-15848, __F.App’x__, 2016 WL 3976532 (9th Cir. July 25, 2016). Lee was a former employee of ING Investment Management, LLC before he became unable to work from symptoms related to hepatitis C and cirrhosis of the liver. Lee applied for and received long term disability benefits for nearly one year before the claims administrator terminated his benefits for his refusal to attend a neuropsychological evaluation. A neuropsychological evaluation is an assessment of how one’s brain functions and is often use to demonstrate cognitive impairment. The Ninth Circuit Court of Appeals determined that the claims administrator could terminate Lee’s benefits for refusing to attend the evaluation since the terms of the disability plan provide that refusal to attend an IME is a sufficient basis to terminate benefits.
There are several ways you can make sure the IME you attend is fair, or at least properly documented, in the event that the insurance company relies on the examination report to deny or terminate your long term disability benefits. Our attorneys advise clients from all over the Bay Area on how to protect their benefits from an improper termination. If an insurance company is requiring that you attend an IME, consult with a knowledgeable ERISA attorney about your rights under the policy.