Do I Have to Go to an Independent Medical Examination Ordered by My Long Term Disability Insurance Company?
- Matthew Maddox
- Jun 27
- 14 min read

Yes. When pursuing a long term disability claim, your insurance company may require you to attend an Independent Medical Examination (“IME”). This examination is not conducted by your own treating physician but by a doctor selected by your insurer. Ostensibly, the purpose of the IME is to offer an independent assessment of your medical condition. However, it’s important to approach this with caution as the doctor is paid by the insurance company, and the IME can significantly influence whether your claim is approved or denied, often serving the insurer’s interests.
As a claimant, it’s essential to understand what an IME entails, your obligations, and how to protect your rights throughout the process. This article will answer common questions about IMEs and discuss what steps you can take if you believe the IME report is inaccurate or biased. By being informed and prepared, you can navigate the IME process with confidence and safeguard your right to the disability benefits you deserve.
What Is an Independent Medical Examination (“IME”) in the Context of Long Term Disability Claims?
An Independent Medical Examination (“IME”) in the context of long term disability claims is a medical evaluation conducted by a doctor who is not your treating physician and is selected by your insurance company. The stated goal of the IME is to independently assess your medical condition and your capacity to work. However, be cautious, as your insurance company uses the IME to collect additional information about your disability, potentially leveraging it to justify a decision to deny your claim.
During the IME, the doctor will review your medical history, perform a physical examination, and may inquire about your symptoms and limitations. It’s important to note that the IME doctor, who is often paid by the insurance company, will prepare a report that could heavily influence the insurer’s decision-making process regarding your long term disability benefits. This report, sent directly to the insurer, may not always work in your favor, reflecting the interests of the company over your own needs.
Am I Required to Attend an IME Ordered by My Insurance Company?

Yes, you are generally required to attend an Independent Medical Examination (“IME”) ordered by your insurance company as part of your long term disability claim. Most long term disability insurance policies include a provision that allows the insurer to request an IME to assess your medical condition and determine your eligibility for benefits. Failing to attend the IME could result in your claim being denied or your benefits being terminated, as your insurance company may view your refusal as non-cooperation.
However, it is important to understand that while you must attend the IME, you also have rights during this process. You can take steps to protect yourself, such as ensuring the examination is conducted fairly and that the doctor chosen is appropriate for your condition. If you have concerns about the IME, it’s a good idea to consult with a long term disability attorney to discuss your options and how best to approach the examination.
How Often Can My Insurance Company Require Me to Undergo an IME?
The frequency with which an insurance company can require you to undergo an Independent Medical Examination (“IME”) varies depending on the terms of your long term disability policy and the specific circumstances of your case. Generally, there is no strict limit on how often an insurance company can request an IME, but they must have a reasonable basis for doing so.
Typically, an insurance company might request an IME:
When your claim is initially being evaluated;
When there are changes in your medical condition; or
If they need to reassess your ability to work after a certain period of time.
However, repeated or excessively frequent requests for IMEs may be considered harassment or an attempt to unfairly disrupt your benefits. If you believe the insurance company is requesting IMEs too frequently without justification, you may want to consult with a disability insurance attorney with experience in ERISA. They can help you understand your rights and, if necessary, challenge your insurance company’s actions.
What Happens If I Refuse to Attend the IME?
Refusing to attend an Independent Medical Examination (“IME”) ordered by your insurance company can lead to significant consequences for your long term disability claim. Most long term disability policies require you to cooperate with your insurance company’s requests, including attending an IME. If you decline to participate, your insurance company may interpret your refusal as non-compliance, which can severely impact your claim.
One of the most immediate consequences of refusing an IME is the potential denial of your claim. Your insurance company may argue that your lack of cooperation justifies rejecting your claim altogether. Additionally, if you are already receiving long term disability benefits, your insurance company might suspend or terminate those benefits, using your refusal as grounds to halt payments.
It’s crucial to consult with an experienced long term disability attorney if you have concerns about attending the IME, such as doubts about the fairness of the request or the appropriateness of the selected doctor. A knowledgeable disability insurance attorney can help you navigate these concerns and avoid the adverse effects that could arise from refusing to attend the IME.
Is It Possible to Challenge My Insurance Company’s Request for an IME?

Yes, it is possible to challenge your insurance company’s request for an Independent Medical Examination (“IME”), but doing so requires careful consideration and a strong basis for your challenge. While most long term disability policies include provisions that allow the insurer to request an IME, there are circumstances where you might question the necessity or fairness of the request.
You may be able to challenge the IME request if:
The request seems excessive or unreasonable. For example, if your insurance company is requesting multiple IMEs in a short period without a clear justification, you may have grounds to challenge the frequency of these examinations.
The chosen doctor is not appropriate for your condition. If your insurance company selects a doctor who lacks the expertise to assess your specific medical condition, you can challenge the suitability of the IME doctor.
You have valid medical reasons. If your treating physician advises against the IME due to concerns about your health or the potential impact on your condition, you might challenge the request on medical grounds.
In any case, it’s advisable to consult with a long term disability attorney before refusing or challenging an IME. They can help you assess the validity of the request and guide you through the process of contesting it, ensuring that you protect your rights and your long term disability claim.
What Should I Expect During an IME?

During an Independent Medical Examination (“IME”), you will be evaluated by a doctor who has been selected by your insurance company. The official reason for the IME is to assess your medical condition and your ability to work, supposedly giving your insurance company the necessary information to evaluate your long term disability claim. However, it’s vital to understand the potential biases involved in this evaluation.
Here’s what you can typically expect during the IME:
Medical History Review: The IME doctor will start by reviewing your medical records and history. They may probe into your current condition, treatment history, and any past injuries or illnesses relevant to your disability claim. Expect thorough questioning that might seem aimed at finding discrepancies or pre-existing conditions.
Physical Examination: The examination will focus on the symptoms and limitations you’ve reported. The doctor may perform tests to measure your mobility, strength, reflexes, and other functions pertinent to your disability. This part of the exam can often feel as if it’s more about questioning the validity of your disability than assessing it objectively.
Questions About Symptoms and Limitations: You will be asked to describe your symptoms, their impact on your daily life, and any limitations they impose on your ability to work. The doctor might also ask you to demonstrate certain tasks or movements to directly observe your physical abilities, which can feel like an attempt to find faults in your claims.
Observation: Throughout the IME, the doctor will closely watch your behavior and physical responses. They will note how you move, answer questions, and handle various tasks, often searching for inconsistencies with your reported symptoms.
Report Preparation: After the examination, the doctor will prepare a report that will be sent to your insurance company. This report will include their opinions on your medical condition, the severity of your symptoms, and your work capacity. Frequently, this report is heavily weighted and may lean towards the interests of the insurer.
Approach the IME with honesty, but be cautious. While it’s crucial to provide accurate and consistent information about your condition, be aware of the examination’s skewed perspective due to the doctor’s affiliation with the insurance company. If you have concerns about the process, discussing them with a long term disability attorney beforehand can help you prepare and protect your rights during the IME.
Can I Bring Someone with Me to the IME for Support?

Yes, you can generally bring someone with you to the Independent Medical Examination (“IME”) for support, but there are some considerations to keep in mind. Having a supportive person with you, such as a family member, friend, or a medical professional, can help you feel more comfortable during the examination. However, the role of the person accompanying you may be limited by the IME doctor or the insurance company.
Here are a few points to consider:
Observer Role: The person you bring is typically allowed to observe the examination but not participate. They may be there to provide moral support and take notes, but they should not interfere with the examination process or speak on your behalf unless asked by the doctor.
Doctor’s Discretion: The IME doctor may have specific rules about whether an additional person can be present during the examination. Some doctors may allow it without issue, while others might have concerns about the impact on the exam or privacy.
Advance Notice: It’s a good idea to inform the IME doctor or the insurance company ahead of time if you plan to bring someone with you. This can help avoid any surprises or potential objections at the time of the exam.
Recording the Exam: In some cases, you may want to record the examination or have your support person do so. You may also consider hiring a service that will send a medical professional as a witness to the exam. After the exam, the medical professional will write a statement discussing what transpired, which can refute any inaccuracies from the IME doctor’s report.
Bringing someone with you can provide emotional support and ensure there’s a witness to the examination process. If you have any concerns about how to handle this or what to expect, discussing it with an experienced long term disability attorney beforehand can help you make an informed decision.
How Can I Prepare for an IME?
Preparing for an Independent Medical Examination (“IME”) is crucial to ensure that the examination process is fair and that your condition is accurately represented. Here’s how you can prepare effectively:
Review Your Medical Records: Familiarize yourself with your medical history, including key details about your condition, treatments you’ve received, and how your symptoms have affected your daily life. Being clear on these points will help you provide consistent and accurate information during the IME.
Understand Your Symptoms: Reflect on your symptoms and limitations, and be prepared to explain how they impact your ability to work and perform daily activities. Be honest and specific when describing your pain, fatigue, mobility issues, or any other relevant symptoms.
Stay Consistent: Ensure that the information you provide during the IME is consistent with what you’ve previously reported to your doctors and the insurance company. Inconsistencies can raise red flags for your insurer and potentially harm your claim.
Bring Relevant Documentation: Bring a copy of your medical records, a list of your current medications, and any notes about your symptoms. This can help you answer questions accurately and provide the IME doctor with a clear understanding of your condition.
Dress Comfortably: Wear clothing that allows the IME doctor to easily examine the areas related to your condition. Comfort is important, but you should also ensure that your attire does not restrict the examination process.
Be Honest and Cooperative: Answer the doctor’s questions truthfully and cooperate fully during the physical examination. If you experience pain or discomfort during the exam, communicate this clearly. Do not exaggerate or downplay your symptoms.
Consider Bringing a Support Person: If allowed, bring someone with you for support. They can help you stay calm, take notes, or serve as a witness to the examination.
Consult Your Attorney: If you have any concerns about the IME, discuss them with a long term disability insurance attorney beforehand. They can provide guidance on how to handle the exam and advise you on your rights throughout the process.
By preparing thoroughly for the IME, you can help ensure that the examination accurately reflects your medical condition and supports your long term disability claim.
How Can the Results of an IME Impact My Long Term Disability Claim?

The results of an Independent Medical Examination (“IME”) can have a significant impact on your long term disability claim. The IME is conducted by a doctor chosen by your insurance company, and their findings can influence your insurance company’s decision regarding your benefits.
Here’s how the results might affect your claim:
Claim Approval or Denial: The IME report is a key piece of evidence that your insurance company uses to determine whether you are eligible for long term disability benefits. If the IME doctor supports your claim by confirming your inability to work due to your medical condition, it can strengthen your case for approval. Conversely, if the doctor concludes that you are capable of working, your insurance company may use this as grounds to deny your claim.
Continuation or Termination of Benefits: If you are already receiving long term disability benefits, the IME results can influence whether those benefits continue or are terminated. A favorable IME report might lead to the continuation of your benefits, while an unfavorable report could result in the insurer deciding to terminate them.
Further Investigations: If the IME report raises questions about your condition or the severity of your disability, your insurance company may initiate further investigations, such as requesting additional medical records, conducting surveillance, or ordering another IME.
Legal Challenges: If the IME results are unfavorable and lead to a denial or termination of your claim, you may need to challenge the findings through an appeal or legal action. This process can be complex and may require additional medical evidence or testimony to counter the IME report.
Given the potential impact of an IME on your long term disability claim, it’s important to approach the examination carefully and ensure that your condition is accurately represented. If you have concerns about how the IME results might be used, it’s recommended you consult with a long term disability attorney who can help you understand your options and protect your rights.
What Should I Do If I Believe the IME Report Is Inaccurate or Biased?
If you believe the Independent Medical Examination (“IME”) report is inaccurate or biased, it’s important to take immediate and strategic action to protect your long term disability claim.
Here are some steps you can take:
Request a Copy of the Report: Obtain a copy of the IME report from your insurance company as soon as it becomes available . Review the report thoroughly to identify any inaccuracies, omissions, or biased statements that may not accurately reflect your condition.
Compare with Your Medical Records: Cross-check the IME report against your own medical records and the findings of your treating physicians. Note any discrepancies, such as differences in the diagnosis, symptoms reported, or the extent of your limitations.
Document Your Concerns: Make a detailed list of specific issues you find with the IME report. This can include factual errors, misinterpretations of your medical history, or conclusions that seem to be based on incomplete or incorrect information.
Speak With an Attorney: Given the weight insurance companies often lend the IME reports, it is always recommended that you speak with an experienced disability insurance attorney. A long term disability attorney with experience in ERISA can guide you through the process of rebutting an IME report with your insurance company.
Consult Your Treating Physician: Share the IME report with your treating physician and ask them to review it. They can provide a professional opinion on any inaccuracies or biases in the report and may be able to write a letter or provide additional documentation to support your case.
Prepare a Rebuttal: With the help of a long term disability attorney, prepare a rebuttal to the IME report. This can include a written response that highlights the errors and provides evidence to counter the IME doctor’s conclusions. Your rebuttal should also include statements from your treating physician or other medical experts.
Addressing an inaccurate or biased IME report is critical to ensuring that your long term disability claim is fairly evaluated. By taking these steps, you can help ensure that the true nature of your condition is recognized and that your rights are protected throughout the claims process.
Can My Insurance Company Deny My Long Term Disability Claim Based Solely on the IME Report?
Yes, your insurance company can deny your long term disability (“LTD”) claim based solely on the findings of an Independent Medical Examination (“IME”) report. However, this practice can be controversial and may not always be fair or justified.
Here’s how it typically works:
IME Influence: The IME report is a significant piece of evidence that your insurance company may use to assess your LTD claim. If the IME doctor concludes that you are not disabled or that your condition does not prevent you from working, your insurance company might rely on this report to deny your claim.
Disregarding Other Evidence: In some cases, the insurance company might place more weight on the IME report than on the opinions of your treating physicians or other medical evidence you have provided. If the IME findings conflict with your doctors’ assessments, your insurer may choose to side with the IME doctor and deny your claim.
Legal Grounds for Denial: Insurance policies often grant the insurer broad discretion to determine eligibility for benefits, and they may argue that the IME report justifies a denial. However, denying a claim solely based on an IME report, especially if it contradicts substantial evidence from your treating physicians, can be challenged as unreasonable.
If your claim is denied based solely on the IME report, you have the right to appeal the decision. During the appeal, you can present additional evidence, such as updated medical records, statements from your treating physicians, or expert opinions, to counter the IME findings. Working with an experienced long term disability attorney can help you challenge an unfair denial and ensure that all relevant medical evidence is considered in evaluating your claim.
How Can The Maddox Firm Prove My Long Term Disability Claim?

At The Maddox Firm, we are dedicated to ensuring your long term disability claim is thoroughly prepared, presented, and defended. We understand the complexities involved and employ a comprehensive strategy to prove your claim.
Here’s how we can assist you:
We Examine Your Policy and Assess Your Claim: Our first step is to meticulously review the terms of your insurance policy to understand the specific coverage details and requirements. This enables us to accurately assess your claim based on the defined criteria for disability in your policy, ensuring that we align our strategy accordingly.
We Handle All Communications with Your Insurance Company: To prevent any miscommunications that could adversely affect your claim, we manage all interactions with your insurance company. This includes submitting necessary documentation, negotiating terms, and responding to requests for information, ensuring that your case is presented clearly and effectively.
We Help You Obtain Evidence to Support Your Claim: Gathering robust evidence is crucial. We assist you in compiling comprehensive medical records, expert opinions, and witness testimonies that substantiate the extent of your disability. We also facilitate the arrangement of any additional medical evaluations needed to strengthen your claim.
Handling Independent Medical Examinations (“IME”): When an IME is required, we prepare you for the examination to ensure you know what to expect and how to handle the appointment. We scrutinize the IME report for any inconsistencies or biases and are prepared to challenge its findings if they unfairly undermine your claim.
We Handle Appeals and Litigation: If your claim is initially denied, we are ready to pursue all avenues of appeal. Our team is equipped to handle administrative appeals with your insurer and, if necessary, litigate the case in court to seek the benefits you are entitled to.
A short term disability or long term disability claim can be a complicated process. If you need help during the claims process, with appealing a claim denial, or with litigating a final adverse short term or long term disability decision, The Maddox Firm can help. The experienced team at The Maddox Firm will examine your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim. Our New Jersey and New York long term disability attorneys help clients nationwide.