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LTD carrier asking for IME
Mar 13, 2006

I am 50 with 70 T-cells and an undetectable viral load. I went on LTD eight years ago (my T-count was less than 200). In addition to the LTD, I was approved and receive SSDI and Medicare (parts A, B and D). My Long Term Disbility carrier is now asking for an IME (Independent Medical Examination) to review my claim. Are they trying to knock me off from anxiety or can they possibly prove I am more able to work now than I was eight years ago? I tried a one year "trial work period" four years ago with my former employer and just couldn't stay healthy enough to get my job done. I loved my job and I miss it. I have been treated for depression, heart disease, shingles, many pesky respiratory infections and several skin cancers. In addition to the pill regimens, I have received IVIG infusions to boost my immune system, and injectable HGH and cosmetic facial surgery to counteract lipodystrophy. I know all LTD carriers and policies are different. My LTD carrier has reviewed my records over the years- so why would they now ask for an IME now? If my meds do stabilize my health for awhile- does that mean they can cancel the claim and send a 50 year old with AIDS back out to look for a job at a fraction of what he earned when he was able-bodied? What should I expect from the actual medical exam? How do I know if the IME the LTD hires will be experienced in HIV. Should I find a specialty attorney for legal advice upfront? Thank you.

Response from Ms. Franzoi

Most LTD carriers ask for an IME periodically if one has been on LTD for awhile. The reason they do this is to make sure that the person is still disabled as defined in the plan. After the IME, what steps, if any, the LTD carrier takes will depend on the results or findings of the examination and the definition of disability in your plan. Some plans define disability as disabled from your own occupation and others define it as disabled from your own occupation for a period of time and then any occupation for which you are reasonable qualified thereafter. You should insist that the physician chosen is experienced in HIV. Obtain his name in advance and ask your physician about the proposed examiner's qualifications. I also suggest that you see this IME armed with information from your physician, including a letter stating why, with medical back-up, that your physician feels you are disabled and unable to work. Having Social Security disability should work in your favor. You can contact a specialty attorney upfront or wait until the results are in and contact such an attorney only if the LTD carrier proposes to cancel your benefits. There are often residual disability benefits in LTD plans that allow you to return to work while still keeping your LTD, until a detrmination can be made whether or not you are actually capable of returning to work full time. Check your plan to see if this benefit is available.



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