Psychiatric IME and pre existing conditions

1

I had my psychiatric IME and the psychiatrist is doing a full history of symptoms of mental health since I was 14.

I claimed disability for the company I was working for, about 6 years after starting to receive benefits.

Here is the clause in the master policy:

“ Pre-Existing Condition Limitation
This policy does not cover any disability which results directly or indirectly from, or is in any manner or degree
associated with or occasioned by a pre-existing condition.

However, this limitation will not apply to a disability which begins more than 12 months after your insurance began.

If, at any time, an employee’s gross monthly benefit increases because of an increase to the no-evidence maximum, the amount of the increase to the employee’s gross monthly benefit will not be payable if the employee’s disability results directly or indirectly from, or is in any manner or degree associated with or occasioned by a pre- existing condition.

However, this limitation will not apply to a disability which begins more than 12 months after the increase to the employee’s gross monthly benefit.
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Pre-existing condition means any condition or symptom for which, during the 6 months just prior to the date that his insurance began:
 you consulted a physician or other healthcare provider;
 you received any health-related care, advice, treatment or services (including diagnostic measures) from or on
the advice of a physician or other healthcare provider;
 you incurred any healthcare expenses;
 you took any prescribed medication; or
 a prudent person would have consulted a physician or other healthcare provider, would have filled a
prescription, or would have continued to take medication previously prescribed.

If there has been an increase to your gross monthly benefit because of an increase to the no-evidence maximum, then pre-existing condition means any condition or symptom for which, during the 6 months just prior to the date of the increase to your gross monthly benefit:
 you consulted a physician or other healthcare provider;
 you received any health-related care, advice, treatment or services (including diagnostic measures) from or on
the advice of a physician or other healthcare provider;
 you incurred any healthcare expenses;
 you took any prescribed medication; or
 a prudent person would have consulted a physician or other healthcare provider, would have filled a
prescription, or would have continued to take medication previously prescribed.
Pre-existing condition includes any such condition or symptom whether or not such condition or symptom was diagnosed or correctly diagnosed”.

Am I safe because I worked for 6 years before claiming disability or they can still screw me?

Thanks

2

Based on what you shared you are good.

If you weren’t eligible your insurance company wouldn’t bother with an IME…they would just deny your benefit claim based on the pre-existing clause.

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3

If it is interesting to anybody who going through this, the psychiatrist was asking a ton of questions like: Between the ages of 14-17, how many times per week did you feel (insert symptoms of depression/anxiety). He did this with every period of my life. I’m in my 40s now. He documented everything answer and was forcing me to answer when I was responding “I don’t know, that was 25 years ago”.

He didn’t want to engage in any exchange that was not precise. For example, having good days and bad days, or any “it depends on how I felt that day”.

It was definitely a 100% legal assessment. Kept 100% honest, but I will definitely not be able to be 100% accurate in a second assessment. Not that I’m trying to lie or cover, but he forced me to answer questions where he would’t accept “I don’t know” or “I don’t remember” answers, if that makes sense.

It took about 7 hours to complete.

4

I would push back harder with the “I do not recall” and “I have no idea” if I in fact did not recall and had no idea. Likewise with the some days/good days/bad days. Otherwise he’s just asking you to make stuff up.

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5

Hello. Make sure your attending physician gets a copy the IME report. Ask your physician to give you a copy, and make sure there are no mistakes in it.

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