When Insurance Companies Use IMEs Against You

When you apply for disability insurance benefits, your insurer may schedule an independent medical examination (IME). The term makes it sound neutral, but in reality, these exams often serve the insurance company’s agenda. Instead of supporting your recovery, an IME may be used to minimize your symptoms, question your diagnosis, or justify cutting off benefits.

For many claimants, the IME becomes a turning point in the claim evaluation process. A single report can outweigh years of treatment records from your own doctor. Understanding how IMEs work—and how insurers use them against you—can help you protect your rights and safeguard your claim.

What Is an Independent Medical Exam (IME) in a Disability Claim?

An independent medical exam (IME) is a medical evaluation arranged by your disability insurance company. Rather than relying on your treating physician’s medical opinion, the insurer sends you to an insurance company doctor for a one-time assessment.

The exam’s stated purpose is to collect additional medical evidence for your claim evaluation. In reality, insurers often select doctors who regularly work for them. This practice creates legitimate concerns about whether the exam will be truly impartial.

The contrast between a treating physician and an IME provider is one of the most significant issues in disability claims:

• Treating physicians are aware of your full medical history and have been following your progress over time.
• IME providers may spend 20 minutes with you before drafting a detailed report that heavily influences the outcome.

Insurance companies often give IME reports substantial weight when evaluating claims, even though these one-time exams provide only a brief snapshot of your health and rarely capture long-term functional limitations.

What to Expect During the IME

The independent medical exam (IME) process usually begins when you receive a notice from your insurance company. Attendance is mandatory—missing the exam could put your disability claim at risk. During the appointment, the doctor may:

• Review your medical history and prior treatment records
• Ask questions about your daily activities, symptoms, and work history
• Conduct a physical examination or order basic diagnostic tests

Some exams are brief and rushed, while others involve detailed questioning designed to catch inconsistencies in your answers. In certain cases, insurance companies also combine surveillance with the IME. This means they may secretly observe or record your activities before or after the appointment, comparing that footage with your statements.

Once the exam is complete, the doctor submits a written report to the insurer. These reports typically include an impairment rating, an assessment of functional limitations, and an opinion on whether you can return to work. Unfortunately, IME findings often minimize symptoms or contradict the treating physician’s records, justifying insurers’ denial of disability benefits.

How to Prepare for Your IME

Proper preparation before an independent medical exam (IME) can make the difference between a fair evaluation and a biased report. Many claimants feel nervous heading into the appointment, but taking a few intentional steps can help you stay confident and in control.

• Review your medical records. Refresh your memory on your diagnosis, treatment history, and current symptoms. Knowing your details ensures your answers are clear and consistent.
• Be honest, yet specific. Don’t exaggerate your condition, but avoid downplaying it. If pain worsens with activity, explain precisely how and when it happens.
• Consider bringing a witness. A trusted friend or family member can sit in and later verify what actually occurred during the exam.
• Document everything. After the appointment, write down what tests were performed, how long it lasted, and any concerning interactions.
• Request the report. You are entitled to review the IME doctor’s report and understand how the insurer plans to utilize it.

If the report conflicts with your treating physician’s opinion, you may need a second opinion or further medical evidence. In appeals, attorneys often highlight contradictions, compare findings with existing medical records, and, if necessary, prepare testimony for an administrative law judge.

Protecting Your Disability Claim

Insurance companies often use IMEs to protect their bottom line rather than provide an accurate picture of your health. A single negative report can undermine months of treatment, weaken your claim, and threaten your financial stability. Without the right response, an IME may become the primary reason for a disability denial.

At Capitan Law, our attorneys advocate for claimants throughout Philadelphia and its surrounding communities. We recognize the tactics insurers rely on, from surveillance to reports written by doctors they regularly hire. If your insurance company is using an IME against you, contact (267) 419-7888 or message us to discuss your options.