Hi. I hope the article below might be helpful to you.

*************
Advice for Insurance Claimants Required to Submit to Their Insurance Company's "INDEPENDENT MEDICAL EXAMINATION"

Bernard Kansky, a United States attorney, has won landmark cases for CFIDS/ME/FM in the past.

Bernard Kansky, a United States attorney, is a founding member of The National CFIDS Foundation, Inc. and has won landmark cases for CFIDS/ME/FM in the past. (Rose v Shalal is the most famous) He's been in practice for over 30 years after working, while in law school, with F. Lee Bailey. About 50% of his practice is now CFIDS related and he offers more than half an hour free consultations to people all across the US. He's often taken cases out of state, since in the United States, unlike Canada, you are dealing with the LTD or the federal government and don't need a local attorney. He's been nominated to the CFS Co-ordinating Committee.

Bernard Kansky has given permission to publish the following letter that he sent to Mary Ellen, Manger of Special Projects for the National ME/FM Action Network. In it, he describes how he advises his clients to deal with the Independent Medical Examination when it is requested by their long-term disability insurer. Here is his letter.

Preparation is essential to afford any patient a better chance for success in these one-sided and arbitrary examinations arranged by the insurance companies or the long-term disability plans

I am an attorney in Massachusetts who has become involved in assisting CFIDS/ME/FM patients through these reviews, in addition to helping them obtain disability benefits initially.

As you know, the purpose of the insurance company is not to obtain an impartial review, but to obtain a medical opinion, which could justify the discontinuance and/or denial of benefits.

The best ways to prepare for these are to send written certified notice to the insurance company requesting a written reply from the company and/or from the doctor indicating what percentage of his/her practice is devoted to diagnosing and treating patients who are totally disabled by the same conditions as well as obtaining a copy of this Md.'s curriculum vitae including any articles he or she has published which related to CFIDS/ME/FM.

Assuming that this is not timely in forthcoming before the scheduled exam, again in writing, by certified mail, request a continuance of the time scheduled for the exam so that your primary care physician may have an opportunity to review the IME's credentials as stated above.

Also request that any report generated by the IME be simultaneously forwarded to you and your primary care physician and ask the adjuster to put it in writing to you, the basis for the adjuster or the company selecting this particular MD to conduct the IME.

If the materials requested have not been satisfactorily provided, then ask again in writing by certified mail return receipt requested that the exam be continued (rescheduled) until such time as you have been provided with the curriculum vitae etc. of the examining IME and the other materials requested.

You should never attend an IME alone. Try to have them provide you with an MD who is close to your home. The reason is that you should never attend an IME alone. Have a friend or relative drive you to the IME's office and make the time of the appointment convenient for you and friend or relative. The further away from your home the exam is scheduled, the more inconvenient for you to have a friend or relative take you, stay with you, act as sergeant at arms and bring you back home.

Be sure to have the friend or relative who takes you to this visit be one who is outspoken, not shy and able to intervene in your behalf if, as and when he or she feels based upon your reactions that the exam is going to far, has gone too far and/or is too lengthy and causing your to experience extreme discomfort or excruciating pain.

Never go to any such exam without such a friend or relative taking you, staying with you and bringing you home. If during the course of the exam, it is necessary to lie down, use the facilities, or drink a beverage, do not hesitate to have your friend ask as soon as you indicate what (true) reactions you are experiencing during the testing process, which dictates this type of relief. Also, this type and form of relief may be required several times during the IME test.

This is a time for candor not courage. It is imperative that you speak up and tell the IME examiner exactly what it is that is causing pain and/or discomfort to you at the time. If the IME examiner does not heed your explanation, then have your friend or relative intercede (tell him/her off) and explain what it is that is causing the pain or discomfort and/or the need for a break.

Before anyone should even attempt to attend such an IME examination, in addition to the above, you should determine the nature and extent of the testing and the amount of time allocated for the testing. If the time allocated exceeds usual tolerance levels, have the insurance company or the MD examining you break it up into two or three smaller visits, or ask to take home the rest of any written multiple choice exam so that you can finish it at your own more gradual pace.

In the event of the testing process becomes so overwhelming and you feel extremely sick or are having problems with overwhelming pain, weakness, exhaustion or light headedness etc., and if absolutely warranted, don't hesitate to let your friend or relative take charge of the situation and call an ambulance on your behalf to take you to the nearest emergency room. No examining MD cares to have any patient who walked into this office be carried out of his office on a stretcher to an ambulance with sirens wailing and blue, red and yellow lights flashing.

Be sure to find out what the IME's supposed "speciality," is and ask him/her how many time he/she has performed IMEs for insurance carrier or solely for examination for opposing counsel and what percentage of times did he/she agree that the patient suffered the symptoms complained of so severely that he/she agreed that the patient was unable to engage in and more importantly maintain gainful employment activity.

Prepare a list of all of your symptoms and a brief explanation as to how each symptom, separately and in combination effect you so that you are unable to attempt and maintain regular employment activity. Give the IME a copy of this list and the explanations as to the disabling effect of each symptom alone and in combination.

Try to analyze it as experiencing the worst days of the Asian Flu or whatever the IME may understand, 365 days a year, year in and year out, with unpredictable periods of unexpected relief for occasional short durations during any week or month, but that otherwise you are generally (not totally) confined to home for most of each and every day by reason of your physical condition and the medications you try to take to alleviate your condition.

In addition to symptoms, list all medical testing which has been shown to be positive. List all medications which you are taking and have taken over the course of the disability and how each medication, if truthful, had a side effect which in addition to your regular symptoms would prohibit you from working.

Example: Sometimes the pain is so severe that you are unable to get out of bed even to eat a light breakfast. As a result you take medication to take the edge off of some of the pain. The side effects of the medication are such that you become drowsy, sleepy and have difficulty staying awake and to attempt work under those conditions would pose a severe hazard not only to you but also to public as well as your co-workers.

More that likely, the IME will limit your responses to staccato-like answers, allowing you no more that a yes or no answer. I.e. do you ever drive; do you ever make meals; etc. the IME will usually not allow you to explain what really disabled you and how limited you are in doing these chores and not being able to know or plan when you might be able to attempt them.

In addition, if you have done your homework and you know what the IME's supposed speciality is, then you can see another M.D. with the same speciality who knows and understands your disability and have that MD prepare an updated report on your condition to provide to the IME. This should have a bearing on the IME (hopefully) and his/her report may be more inconclusive than negative. Although do not expect miracles.

Also, be prepared in other ways. If the curriculum vitae of the proposed IME MD does not seem to be suitable for evaluating your condition, then in writing by CRR, request the insurance company provide an IME MD who has more background, training, experience and treats patients who have been totally disabled by CFIDS/ME/FM i.e. the disease and condition which disables you.

Have the friend or relative who takes you to the IME, keep accurate and simultaneous notes

Keep some log as to the correspondence between you and the insurance company and also have the friend or relative who takes you to the IME, keep accurate and simultaneous notes and records of the time you went into the examining room, the nature of the exam performed, the questions asked of you and how they were asked [see above-staccato questions subject to "yes" or "no" without opportunity for explanation] and what if anything else was provided to the IME MD [schedule of symptoms and medications and how they prevent work and/or updated confirmatory report of primary care physician indicating total disability from working and the reasons therefor.]

Finally, do not be surprised when ultimately you see a report, which appears to have been prepared for some other patient with some other illness. You might also ask the IME MD what he is being paid to perform the exam and report and be sure to record it in your logbook. Also be sure to record in your logbook, any other conversations between friend or relative and IME MD and or between you and IME MD or any member of staff.