Independent Medical Exam? Anyone had one?

[iwantsimple]

I am in the US, and I am 6 months into my claim for a disability retirement. My case worker just told me that they will be sending me to an independent medical examiner. I will have the name/date next week some time. In the meantime, I'm hoping some of you have had to go through this and might be able to tell me what to expect. I'm very nervous about it, because I have read that they are simply looking for ways to trick you or prove that you are making it all up. My brain is so foggy half the time that I am sure I will say something that makes me sound crazy. I'm very worried about this exam! Please help!

 

[Nielk]

I had one in NY about 7 years ago. I was pleasantly surprised as to how the doctor understood te illness. He didn't physically examine me. He just asked a lot of questions as to my symptoms and what meds I was on or did take in the past. He did some kind of cognitive testing for memory and showed some cards with pictures asking me to describe what I saw.
I wouldn't worry Michelle as far as your brain fog and what you will say. It's part of the illness and might work for your advantage. Just don't be nervous and act as yourself.
Soon after this exam, I got confirmation that I will get SSDI.
Good luck and don't worry!

 

[Ocean]

My exam was awful. They asked me to do things that had nothing to do with my reasons for filing, with my illness or my inability to work. No part of the exam was relevant to my condition or claim. The exam was very short. The conclusions of the exam were contrary to my actual reality as well as to what every single one of my doctors/specialists had concluded and recommended. But if that happens you can always appeal. I guess be prepared for either case, one like mine or one like Neilk's.

 

[fla]

Independant Medical Exam means the result is independent of the patient's condition.

[Insert Name] is healthy and capable of performing his/her job as an [Insert profession here].

 

[iwantsimple]

Hmm...this is a little scary. Mine is for a disability retirement with CalSTRS, so it is different than SSDI. I am worried about how to handle the actual exam. For example, if I am asked to lift my arms over my head, I can do it, but it becomes extremely painful on the way up, and I can't hold them there for more than a few seconds. Should I go ahead and lift them over my head and endure the pain or stop at the point where the pain starts? I have always been a person who pushes through pain as much as possible. Just not sure what is expected at this exam. My regular doctor would expect me to stop when it starts to hurt, but that's because she is thinking of me. The IME will be thinking of the insurance company.

 

[markmc20001]

Hi Michelle. Not sure what Calstrs is. SOunds like some kind of government supplied LTD. If it is an ERISA type LTD plan, instead of a private disabilitly insurance, you have reason to be worried. An Erisa plan allows the insurance to decide whether the insurance company wants to continue paying or not (without any penalty if they cut you off wrongly). Not hard to guess which option they will choose if they are the ones who decide if they pay!

It will be worth your while to contact an ERISA attourney for a consultation to determine what kind of plan you have and how to handle these medical exams. Many insurance companies will try to take advantage, and an IME is a perfect opportunity since they are paying for the opinion.

I think if it is a government supplied policy, you have a better chance of geting fair treatment than with Unum or somebody. Not good to piss off the government employees who have the power to regulate and penalize.

good luck.

 

[iwantsimple]

It's not disability insurance. It's a disability retirement. CalSTRS is the CA teachers retirement system. So I'm applying for disability retirement. I can't find any info online about it. It's like there's no one who has ever gone through the process with them before. Really frustrating. Only found two attorneys in CA who deal with CAlSTRS. Don't know if that's good or bad bit thinking about calling one.

 

[Nielk]

One advice that I can give you that someone gave me (I didn't listen to them) is to bring someone with you and they should be present at the examination.
This way, the doctor will not (hopefully) try to intimidate you into doing things that are not comfortable for you. If something is painful for you to do - stop at that point.
Say; "it hurts too much - I can't go beyond this point".

 

[jajo]

If you belong to a teachers union then get in touch with your rep and appraise them of your situation.
Have someone else present at the examination, they can also take notes.
The examiner will submit a report to the deciding authority - it is unlikely that he/she will have the final say.
If you need a break or cannot comply with something they request you do then say so - don't push yourself into a crash, they won't be there the next day to see it.
Avoid meeting the medical examiner at your own home.
Make notes beforehand of things you think are important - they may not ask that question!
If you think your request for disability retirement could be contested then contact legal services as a back up position.
Good luck.

 

[Ocean]

Is the exam the make it or break it part of the process? You're able to submit material from your doctors and things like that right? I like the idea of speaking to someone in your union if you're able if they're able to help with something like this. I would do as much in advance to protect yourself as possible, whether that means talking to a lawyer or whatever. I had a community organization help me with my appeal and it was a huge help.

 

[Ocean]

Independant Medical Exam means the result is independent of the patient's condition.

[Insert Name] is healthy and capable of performing his/her job as an [Insert profession here].

Do you mean they do not check the person for limitations caused by their condition and that is how it's supposed to be? My exam seemed so absurd because my condition is why I couldn't work and nothing in the exam related to my condition. Unless paralyzed, just about any severely disabled person could have "passed" the exam I had. If that is the way it's supposed to be it seems so strange to me.

 

[iwantsimple]

I've been scouring the internet for lawyers that deal with public employee retirement systems, and they are hard to find. Did find a few in the Los Angeles area, but do I really want to have to travel? Will they even work with someone from 4 hours away? Guess I need to make a few phone calls...

 

[markmc20001]

It's not disability insurance. It's a disability retirement. CalSTRS is the CA teachers retirement system.

"Retirement" sounds much better than "insurance"! Insurance just charges the fees, but does not pay. Hopefully you can retire without hassle.

 

[iwantsimple]

I hope so, too! It's a lifetime benefit, and maybe that's why they are taking so long to make a determination. At any rate, I just want it settled!

 

[Ocean]

Have you checked with your union? They may be able to help. I'd start there in case they are able to offer some resources then you wouldn't have to go looking on your own.

 

[Nielk]

I've been scouring the internet for lawyers that deal with public employee retirement systems, and they are hard to find. Did find a few in the Los Angeles area, but do I really want to have to travel? Will they even work with someone from 4 hours away? Guess I need to make a few phone calls...

When I was searching for laywers for my employee benefit disability (erisa plan), I called many laywers and they would have worked with me long distance. I mailed them my file and they reviewed it. Today, with a computer and scanner, you don't really have tp physically be there. It's definitely worth a shot. With hindsight, I am sorry now that I didn't hire a laywer at the start of my case. After 5 years of paying my disability, they dropped me because of "independant examiners" who never even saw me! They just reviewed my file which 9I thought) was very strong. They lied in their report and there was nothing that I can do about it. I lost the case although I still have SSDI.

Ocean mentioned a great idea. Did you get in touch yet with your union? They might be able to help you.

 

[fla]

Do you mean they do not check the person for limitations caused by their condition and that is how it's supposed to be? My exam seemed so absurd because my condition is why I couldn't work and nothing in the exam related to my condition. Unless paralyzed, just about any severely disabled person could have "passed" the exam I had. If that is the way it's supposed to be it seems so strange to me.

The IME is only a charade "An absurd pretense intended to create a pleasant or respectable appearance." If you have a local M.E. association they can probably recommend a disability lawyer who knows about defending M.E. patients.

 

[iwantsimple]

Have you checked with your union? They may be able to help. I'd start there in case they are able to offer some resources then you wouldn't have to go looking on your own.

I am no longer employed by the school district, so I no longer pay dues. They only help "paying members." The California teacher's union is EXTREMELY self-serving.

 

[iwantsimple]

I'm beginning my lawyer hunt today. I will actually CALL and speak to a few of them! Let's see what I can find... I will update you all... Thanks for the ideas!

 

[Ocean]

With hindsight, I am sorry now that I didn't hire a laywer at the start of my case.

Me too. It never even occurred to me that I'd need to do that. I was very naive about how it works.Besides I was so sick I was barely hanging on as it was. But if I could go back in time I'd absolutely do so now, so I would give that advice to anyone in this position. I know this isn't exactly insurance, it's retirement, but the basic principle is probably at least somewhat similar. Good luck Michelle.