Paper Reviews Vs. Independent Medical Exams In Florida Long-Term Disability Claims

If you’ve filed a long-term disability (LTD) claim in Florida, you may expect the insurance company to evaluate your condition based on your doctor’s records. However, you may find your claim denied based on a review by someone who has never examined you, or after being sent to a doctor chosen by the insurer.

These are two of the most common tactics used in LTD claims: paper reviews and independent medical exams (IMEs). Both can significantly impact your benefits. If the insurer is questioning your claim, our experienced Jacksonville long-term disability lawyer can help you respond before it’s too late.

The Difference Between Paper Reviews and IMEs in Florida LTD Claims

A paper review happens when the insurance company hires a doctor to review your medical records without ever seeing you in person. This doctor then gives an opinion about whether you can work. Here’s how a paper review can affect your claim:

• The reviewing doctor may never speak with you or your treating providers and relies only on written records.
• They often focus on what’s “missing” from your file, rather than actual symptoms.
• Their opinion may directly contradict your doctor’s findings.

In contrast, with an IME, the insurer selects and pays the doctor performing the exam, which can influence the outcome. Here’s what to expect:

• A brief, one-time evaluation, with surveillance or observation before or after the exam.
• Questions or tests that don’t match your actual job duties or daily challenges.
• A report that may downplay symptoms or suggest you can return to work.

Unfortunately, insurers often use both tests to deny or terminate LTD benefits in Florida.

How to Protect Yourself During LTD Evaluations

Under U.S. Federal Regulations, insurers must establish and maintain reasonable claims procedures. While you can’t always avoid a paper review or IME, you can prepare for them. Here’s what to do:

• Make sure your medical records clearly describe your functional limitations, not just your diagnosis.
• Be honest during exams, and don’t minimize or exaggerate symptoms.
• Jot down what happens during your visit, including how long it lasts and the questions asked.
• Follow up with your doctor afterward to document any issues or concerns.
• Speak with an experienced Florida LTD lawyer before or after an evaluation to understand your rights.

If your claim is denied after a paper review or IME, you have the right to file an appeal under ERISA (the Employee Retirement Income Security Act of 1974).

To Speak With Our Experienced Florida Long-Term Disability Lawyer, Request a Consultation Today

At Farrell Disability Law, we have extensive experience dealing with LTD insurers and know how often they use paper reviews and IMEs deny valid disability claims. If your benefits were delayed, reduced, or denied based on one of these evaluations, we provide the trusted legal guidance you need to file an appeal.

Don’t delay. Call or contact our office today and request a consultation in our Jacksonville or Orlando office to speak with an experienced Florida long-term disability lawyer.

Sorces:

dol.gov/general/topic/health-plans/erisa

ecfr.gov/current/title-29/subtitle-A/part-2560/section-2560.503-1