Thursday, December 5, 2013

Prudential Cancels IME

Disability insurance companies make it a habit of asserting rights under group disability insurance policies that do not exist, such as interviews by investigators when only medical exams are allowed. 

Prudential cancelled a demand that my client attend a so-called independent medical examination (“IME”) after I insisted that my client be allowed to videotape it. Prudential asked for the IME because I submitted reports form treating physicians and diagnostic test data that all show she remained disabled – there was no change, let alone improvement, in her medical conditions. 

As an initial matter, I objected to the location of the IME. I explained that because my client’s condition makes travel difficult, if Prudential insisted on an IME, then it should be located within a 10-mile radius of her residence. She lives in Queens which is jam packed with health care professionals. There was no excuse for requiring my client to travel a further distance as there are countless physicians who work where she resides. There certainly was no reason to make my client travel across two counties, over 20 miles, to see a doctor who practiced medicine in a specialty that was unrelated to her disability. While Prudential might have the right under the policy to an IME, it does not have the right to schedule an IME at an unreasonable location. 

Regardless of the unreasonable location of the IME, I stated that my client would attempt to comply. However, I warned Prudential that because they scheduled the IME at an unreasonable location, there was a very good chance that she would not be able to remain for its duration, which is why I suggested having the IME at a closer location. Prudential seemed to think scheduling an unreasonable IME was not a problem because they offered transportation. I explained that offering transportation was irrelevant because I had informed Prudential that the claimant would appear with a witness who would drive her. More importantly, the fact that Prudential would provide transportation would not reduce the amount of time that it would take to get to the unreasonable location of the IME. Furthermore, Prudential’s statement that the driver could stop so the claimant could stand and stretch was irrelevant because she needs to lie down, not stand up, to relieve her pain. 

Prudential canceled the IME because I stated that the claimant’s witness would videotape it, to which they objected. In half a dozen letters, I stated that there was absolutely nothing in the Group Policy that forbids videotaping an IME. Each time I told Prudential that if they disagreed to send me a copy of that part of the Policy that they claimed forbids it. They never did, which was an admission that no such provision existed. I explained to Prudential that the fact that the IME doctor did not want the IME videotaped was irrelevant to the terms and conditions of the Group Policy, and that they were breaching the Policy by imposing a condition that did not exist in it. I made it clear that I did not refuse to allow my client to attend the IME with her companion. To the contrary, I repeatedly told Prudential that both the claimant and her witness would attend the IME, even though they had scheduled it in an unreasonable manner so as to inconvenience her. Faced with admitting there was nothing in the Policy prohibiting a claimant from videotaping the IME, Prudential chose to cancel it.

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