Posted on Thursday, January 1st, 2026 at 8:00 am
Insurance companies often use an independent medical exam for disability to question your condition’s severity. While the name suggests these exams are neutral, insurers use them to deny or terminate long-term disability benefits. They rely on these evaluations to create evidence that contradicts your treating physician’s findings. Understanding how these independent medical exams work and why insurers request them is the first step to protect your right to benefits.
Why Choose Capitan Law, PLLC for Your Disability Claim?
Capitan Law, PLLC focuses exclusively on disability-related claims. We provide the knowledge you need when facing a powerful insurance company. Our legal team includes Joe Capitan and Greg Scott. Both attorneys have been recognized as Super Lawyers Rising Stars. We understand the tactics insurers use because we fight them every day.
From our office in Philadelphia, we represent clients across Pennsylvania and nationwide. We work on a contingency fee basis. This means you pay no money up front. Additionally, you pay no fees unless we win your case. Our attorneys have extensive experience handling claims against major insurers like Cigna/LINA, MetLife, and Unum. We help protect your interests at every stage.
What Is an Independent Medical Exam for Disability?
An independent medical exam (IME) is a physical or mental evaluation an insurance company requests. In long-term disability (LTD) and ERISA claims, the insurer has a right to ask you to see their doctor. They claim this is necessary to get an “objective” look at your functional limitations.
However, the term “independent” is often a myth. The insurance company selects the doctor and pays for the exam. Often, they use third-party vendors to find these doctors. These vendors maintain a network of doctors who frequently perform these evaluations. Because the insurer pays the bill, the doctor has a financial incentive to support the insurer’s goals.
How Insurance Companies Select IME Doctors
Insurance companies are selective about the medical consultants they use. They often choose doctors who rarely treat actual patients. Instead, these professionals spend most of their time performing evaluations for insurance companies.
When you attend an IME, no doctor-patient relationship exists. The physician is not there to treat you or help you recover. Their only job is to evaluate your condition and report to the insurance company. This lack of a therapeutic relationship often leads to reports that ignore your pain levels. Instead, they focus on narrow physical findings that favor a denial.
Common IME Traps Used to Deny Benefits
Insurance companies use several common traps during the IME process to challenge your claim. One frequent trap is the “brief exam.” You may spend hours in a waiting room. Then, the doctor spends only ten or fifteen minutes evaluating you. Despite this short interaction, the doctor may produce a long report claiming you can return to work.
Another common tactic is the “malingering” accusation. The doctor may use subjective observations to suggest you are exaggerating your symptoms. For example, they might note that you moved easily in the waiting room. Then, they claim you appeared to struggle during the exam. Insurers also use inconsistency traps. The IME doctor compares their findings to old medical records or surveillance footage. They look for any small discrepancy to question your credibility.
The Surveillance Tie-In: Watching You Before and After the Exam
Surveillance is a major part of the IME process. Insurance companies often hire private investigators to follow you. They may record you walking from your car or stopping for gas.
The insurer then compares this video footage to your performance during the exam. If the video shows you moving freely, they will use it as evidence against you. They use these single snapshots of activity to argue that your disability is not severe. This is true even if that activity caused you significant pain afterward.
How to Prepare for Your Independent Medical Exam
Preparation is important when you have an IME scheduled. Start by reviewing your medical history and current symptoms. This helps you speak clearly about your limitations. Consistency is key. Your descriptions of pain and functional issues should match what you told your own doctors.
During the exam, be honest but do not downplay your symptoms. If a movement causes pain, say so immediately. You should also consider bringing a witness or recording the exam if the law allows it. Finally, document the exact start and end times of the evaluation. This shows how much time the doctor actually spent with you.
How IMEs Impact ERISA Disability Appeals
The IME doctor’s report becomes a permanent part of your administrative record. In ERISA disability appeals, this record is often the only evidence a judge sees. This makes it important to challenge a biased IME report quickly.
At Capitan Law, PLLC, our legal team works to counter these reports. We use vocational experts and detailed rebuttals from your treating physicians. We point out factual errors in the IME report. Furthermore, we highlight where the insurance doctor ignored objective medical evidence like MRIs or CT scans. Challenging the IME is a necessary step to build a strong appeal.
Frequently Asked Questions About IMEs
Can I refuse to attend an independent medical exam for disability?
In most cases, no. Most disability policies require you to attend an IME if the insurer requests one. Refusing to go can give the insurance company a reason to deny your benefits immediately.
What should I not say during an IME?
Avoid exaggerating your symptoms, but do not “tough it out.” Do not tell the doctor you are “fine” out of habit. Also, avoid speaking negatively about the insurance company or your employer. The doctor will record everything you say.
Can I bring my own doctor to the insurance company’s exam?
You generally cannot have your own doctor perform the exam. However, some policies allow you to have a witness present. Having a third party take notes can help make sure the report is accurate.
What happens if the IME doctor disagrees with my treating physician?
The insurance company will almost always side with the IME doctor. This is why you need a legal team to help your doctor write a strong rebuttal. They can point out why the insurance doctor’s conclusion is incorrect.
Contact Capitan Law, PLLC Today for a Free Consultation
If your insurance company has scheduled an IME, do not go alone. The tactics insurers use protect their profits, not your health. You need an advocate who understands the law and knows how to challenge biased reports. Our success stories demonstrate our commitment to our clients. Contact Capitan Law, PLLC today to discuss your case. We offer free consultations and will help you understand your rights under ERISA. If you are also applying for Social Security Disability, we can help coordinate your claims. Call us at (267) 419-7888 to get the help you deserve.
