Are You Required to Attend a Neuropsychological IME for Disability Insurance?
Disability insurance companies are notorious for requesting Independent Medical Exams (IME or CME) in an effort to try to deny disability benefits. Our disability insurance lawyers have helped thousands of claimants to prepare for these obviously unfair and often biased examinations. Unfortunately disability claimants are required to attend an IME exam and cooperate while being examined. Let’s take a look at a recent ERISA disability denial lawsuit in which a claimant a neuropsychological IME exam but failed to cooperate with the examiner.
Claimant Denied Disability Benefits After 12 Years Due to Failure to Cooperate
A Federal Appellate Court recently upheld the termination of disability pension benefits under an ERISA governed plan for a claimant who had been on claim for 12 years due in part to her failure to cooperate during a Plan ordered Independent Medical Examination (IME). In finding that the Plan did not abuse its discretion in denying benefits, the Court noted that the Plan conditioned continued eligibility for disability benefits on “compliance with recommended treatment” and “cooperation during evaluations requested pursuant to the Plan.” During the course of the claim, one of the claimant’s treating doctors noted that she was no longer in compliance with recommended treatment, which in turn raised a red flag and prompted an evaluation of her claim by the Plan.
In evaluating the claimants continued eligibility for disability benefits, the Plan informed the claimant that she must attend an IME to include neuropsychological testing. Following initial refusal by the claimant, she finally underwent the testing. The results of the testing indicated that she put forth inadequate effort, exaggerated her symptoms, and possibly malingered. Based upon what was deemed her failure to put forth adequate effort and “cooperation during evaluations requested pursuant to the Plan” her benefits were denied. The claimant appealed the denial twice, filed a lawsuit and lost, and then appealed the initial court decision to the Appellate Court.
Appellate Court Agrees With Lower Court And Upholds Disability Denial
During appellate review, the Court noted that the claimant was granted the opportunity to submit additional documents to explain her test performance, and that the information provided on appeal failed to show she was incapable of participating in the IME. The Court, in rendering its decision, even points to the fact that the Claimant had been able to adequately perform the requested testing less than two years earlier.
The Court ultimately made the following findings:
- It was not unreasonable for the Plan to require attendance at two IME exams in an 18 month span;
- It was not unreasonable of the Plan to require her to attend the neuropsychological IME; and
- The claimant’s failure to comply with treatment and to cooperate during the IME evaluation were reasonable grounds for termination of benefits.
Lessons Learned From This Recent Disability Denial Lawsuit
This recent case serves as a reminder that it is extremely important that a claimant comply with all provisions of a Plan. We have previously discussed the importance of attending required Independent Medical Examinations, and that the failure to do so could result in the denial of benefits. This case takes this discussion and evaluation one step further by holding that attendance alone is not enough, that adequate effort and cooperation must be given during an IME. However, it must be noted that the ERISA governed Plan at issue in this case specifically stated “cooperation during evaluations requested pursuant to the Plan.” Each Plan (or Policy) can be written with different language, so it is important to know and understand your duties under your particular Plan. This case also serves as a reminder that disability benefits, be it from a disability pension plan or disability insurance policy, are not guaranteed benefits and that entitlement to benefits will be continually reviewed on a month to month basis. Lastly, this claimant could avoided this entire situation if she had complied with her treating physicians treatment plan and had supporting documentation from her treating physician.
For more information on Independent Medical Examinations please see “What should I expect when I attend an IME exam requested by my disability insurance company” and “Do I have to attend an IME requested by my disability insurance company?“. If your insurance company is requesting you submit to an IME or you have questions regarding your claim for benefits please contact Attorneys Dell and Schaefer for a free consultation.
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Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.
Submit A Strong Appeal Package
If your disability insurance benefits have been wrongfully denied, then our disability insurance lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.
Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of disability. We encourage you to contact any of our long-term disability attorneys for a free immediate review of your disability denial.
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We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.
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Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.
Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.
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Questions About Hiring Us
Who are Dell Disability Lawyers?
We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.
Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.
We offer disability insurance attorney representation nationwide and we welcome you to contact any of our LTD lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 900 videos and regularly provide tips to help protect your disability benefits.
Who do you help?
Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.
Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.
A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
Do you work in my state?
Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability insurance lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.
What are your fees?
Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.
The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.
In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.
Do I have to come to your office to work with your law firm?
No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, or video conferencing sessions. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.
How can I contact you?
When you call us during normal business hours you will immediately speak with a disability insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.