If you have disability insurance
and have been denied benefits . . .
If you have disability insurance coverage, are psychiatrically disabled, and have either been denied benefits or need help in presenting the clinical merits of your case, The Forest Hills IPA (FHIPA) may be able to assist you.
Established in 1987 by Dr. Leonard Grossman, FHIPA is a nationwide network of licensed mental health professionals and consultants. We specialize in forensic psychiatric, psychological, neuropsychological, and IME evaluations and related professional consulting services.
What is an IME?
Before going into further detail on our individual consulting services, we'd like to introduce you to the term "I M E," which is an acronym for "Independent Medical Evaluation." The term refers to any psychiatric or medical evaluation performed by a neutral (i.e., independent) practitioner who has no treatment, financial, or professional relationship with the examinee or the examinee's care givers.
IMEs are typically requested by insurance companies to independently evaluate disability status and/or appropriateness and need for treatment issues. Similarly, HMOs and PPOs will also sometimes request that an IME be performed on a member or receipient of benefits.
Why are IMEs Necessary?
Of necessity, insurance companies must periodically perform IMEs in disability cases to corroborate disability status and make sure benefit receipients are under the care of a physician and are being appropriately treated. Without the IME process, it would be impossible for insurers to offer disability coverage.
At the same time, we know that physicians often have honest professional disagreements over diagnostic and disability issues. Your own care giver may stongly feel that you are presently disabled, while an IME doctor disagrees and finds you able to return to work.
While the terms and conditions of disability policies vary, benefit receipients who disagree with an IME finding have the right to contest those findings, and present additional medical evidence which supports their position.
Clinically Documenting your Disability
Contesting an insurer's determination that you are not (or no longer) eligible for disability benefits is a complex and challenging undertaking. It's a task made even more difficult when you're experiencing a disabling psychiatric illness. This is especially true when your mental health difficulties are secondary to a chronic medical condition such as Chronic Fatigue Syndrome, Multiple Sclerosis, Hepatitis C, AIDS, etc.
One avenue of response is to seek competent legal advice as to the contractual nature of your policy and its obligations and exclusions. But if you've been turned down or had benefits terminated because of an IME finding, you may also need expert clinical advice.
While your medical/mental health care provider may be well-acquainted with your clincial situation, and may be providing excellent care and support, you're going to need a second opinion, and you're going to need input and advice from professionals familiar with insurance and benefit reinstatement issues.
Over the years, FHIPA has provided clinical consulting services in hundreds of psychiatric disability cases. Our intake process is thorough, meticulous, and professional. Each incoming case is assigned to a licensed mental health specialist for critical analysis and peer review. Which type of specialist reviews your case depends on your particular mental health diagnosis.
Once reviewed, we'll advise you of your case's strengths and weaknesses, and discuss the various clinical options which may be open to you for further documenting your illness and disability. One option which often presents itself is sponsoring your own IME.
Sponsoring your own IME
As we've already established, insurers arrange IMEs to independently assess disability status and prognosis. As an insured claimant potentially eligible for disability benefits, you have the right to sponsor and arrange your own IME evaluation. Provided the preliminary clinical preparation is done properly (i.e., your case file is professionally analyzed and reviewed), sponsoring your own IME is an extremely powerful measure for protecting your rights and advancing the merits of your case.
Once you give your approval, FHIPA will arrange your IME and any required testing by locating an appropriate examiner near where you live. We also will meticulously draft a special IME questions letter to make sure the examiner addresses the salient issues of your case. Arranging your own IME is particularly useful in cases in which care givers are in disagreement with the insurer's IME examiner.
Building your Case: Six Essential Steps
In summary, there are six essential steps which, when implimented, can dramatically increase the chances of successfully documenting your disability:
seek competent legal advice regarding contractual issues, exclusions, and coverage limitations in your disability policy.
remain under the care of, and regularly visit, your physician or mental health care provider.
have your case file independently reviewed by an experienced medical or mental health professional.
when appropriate, arrange your own IME to independently document your disability status.
when indicated, include psychological or neuropsychological testing with your IME to document symptom severity.
have your attorney submit the clinical findings from your IME to the insurer and request benefit resumption.
Do I Really Need an Attorney?
You do not need to be represented by attorney to take advantage of our professional consulting services. However, it should be noted that FHIPA does not provide legal advice, nor should the consulting services we do offer be considered a substitute for seeking competent legal advice when required.
In point fact, the best way to employ our services is in a pro-active, pre-emptive way. By this we mean that you do not necessarily have to wait until your claim is rejected and closed to secure our services. Often insurers will give you a chance to submit additional information on your claim before closing the case, or rule that the information submitted by your care giver is insufficient but give you a chance to resubmit additional information in a set period of time. This is a critical stage in which to act decisively, as it comes before the mechanisms of litigation may be put into motion and positions become polarized and solidified.
Call for a Free, No-Obligations Consultation
If you are having eligibility problems with your disability insurance and are interested in knowing more about FHIPA consulting services, call us at our toll free number to discuss your case. The first call to us is free, and there will be no charges until we agree to take your case.
Individual Services
