Challenging Independent Medical Exams (IMEs) in Disability Claims

If your disability insurance company has requested that you attend an independent medical examination, you are not alone, and you are right to have questions. IMEs are one of the most common tools insurers use to challenge legitimate disability claims, and the results of a single exam can determine whether your benefits continue or get cut off entirely. At Monahan Tucker Law, we have spent years helping policyholders who live in or are employed by corporations based in Washington, California, Oregon, Arizona, and Nevada understand their rights when it comes to IMEs and, when necessary, fight back against biased or inaccurate findings.

An independent medical examination (IME) is a medical evaluation conducted by a physician who has no prior involvement in treating the patient, typically at the request of an insurance company. The stated purpose is to provide an objective assessment of the claimant’s medical condition, functional limitations, and ability to work. In practice, however, the insurer selects and pays the examining doctor usually through the use of a purportedly “neutral” third party vendor.  These vendors develop a stable of physicians whom they use over and over again, and who the vendor will not choose to continue to use if the physician does not provide results supporting the insurer, which raises serious questions about how “independent” these evaluations truly are.

This guide explains what an IME involves, what to expect, what to avoid, and how an experienced disability attorney can help you challenge an unfavorable report.

What to Know About Independent Medical Exams (IMEs)

Why Insurance Companies Request IMEs

Most long-term disability insurance policies include provisions that give the insurer the right to require claimants to attend an IME at any point during the claims process. This applies whether you have just filed a new claim or have been receiving benefits for years. If you refuse to attend, the insurer can suspend or deny your benefits outright.

Insurance companies typically request IMEs when they want to:

• Challenge the opinions of your treating physicians regarding your functional limitations.
• Create evidence to justify denying, reducing, or terminating your benefits.
• Identify inconsistencies between what you report to your treating providers and what the IME physician can identify in an exam.
• Question whether your condition meets the policy’s definition of disability.
• Obtain a medical opinion from a doctor more likely to support the insurer’s position.

The fundamental problem with IMEs is the financial relationship between the examining doctor and the insurance company. Physicians who consistently find claimants to be capable of returning to work are more likely to receive repeat referrals from insurers. Doctors whose findings support claimants may find their referral pipeline dries up quickly. This creates a built-in incentive structure that can compromise the objectivity of the exam.

What Happens During an IME

The IME process is relatively straightforward. The insurer selects a physician through a third-party vendor, and the vendor schedules you for an in-person examination. The exam may include:

• A review of your medical records (often selected by the insurer, not you).
• A physical examination or functional testing.
• Questions about your symptoms, daily activities, work history, and job duties.
• Observation of your behavior before, during, and after the appointment.

Everything you say and do from the moment you arrive can end up in the final report. The examining doctor will produce a written report summarizing their findings and submit it to the insurance company. That report will become the primary basis for the insurer’s decision on your claim.

How to Prepare: The Do’s and Don’ts

Proper preparation can make a meaningful difference in the outcome of your IME.

Do:

• Be honest and accurate about your symptoms, pain levels, and functional limitations.
• Arrive on time and behave as you normally would.
• Bring a trusted friend or family member as a witness to observe and take notes. Alternatively, work with your attorney to arrange a nurse observer.
• Confirm in advance that the observer will be permitted. Be aware that depending on the type of IME, the physician may refuse to permit your observer.  Neuropsychological testing in particular generally must be done without an observer as it can compromise the testing.
• Review your own medical records before the appointment so you can speak to your history.
• Bring your own medical records to the exam and provide them to the doctor to ensure the full record is available. 
• Keep answers focused and respond to what is asked.
• Be aware that insurers conduct surveillance, and a primary time for such surveillance is when you are traveling to and from an IME appointment.  Expect that you will be watched and recorded by the insurer that day.
• Even if the insurer does not hire surveillance, your IME physician will be “surveilling” you.  Were you able to drive to the appointment?  Walk to the building without assistance? Sit through the exam without pain?  If these are issues on which your disability claim is based, the IME doctor will absolutely document discrepancies like this between what you claim to be limited in doing compared to what the physician actually observes.

Don’t:

• Exaggerate or minimize your symptoms, as either approach can damage your credibility.
• Claim that you “always” experience something or “never” can engage in an activity.  People have better days and worse days, and it is okay and appropriate to explain that.  Your disability is not based on what you can do on your best day.
• Volunteer information beyond what is asked or engage in extended casual conversation.
• Ask the IME doctor for a diagnosis or treatment advice, as that is not the purpose of the exam.
• Assume the IME doctor is on your side, regardless of how friendly they may seem.
• Fill out any forms or questionnaires that your own attorney has not reviewed first.

How to Challenge an IME Report

If the IME report contains inaccurate findings, incomplete analysis, or conclusions that contradict your treating physicians’ opinions, you have options. An experienced disability attorney can pursue several strategies:

• Presenting counter-evidence from treating physicians: Your own doctors, who have treated you over months or years, can provide detailed reports explaining why the IME findings are incorrect or incomplete.
• Challenging the IME doctor’s qualifications: If the examiner lacks expertise in your specific condition, has licensing issues, or has not stayed current with medical practices, this can undermine their credibility.
• Scrutinizing the examination methodology: If the exam was too brief, if the doctor did not perform appropriate tests, or if the report contains errors about your medical history, these are all valid grounds for challenge.
• Investigating patterns of bias: Some IME doctors consistently produce reports that favor insurance companies across hundreds of cases. Your attorney can research the examiner’s track record.
• Obtain your own IME: Retain a non-biased doctor to complete a second examination of you that refutes the IME.
• Cross-examining the IME doctor: If the case reaches litigation and is not subject to ERISA, your attorney can depose the IME doctor and question the methodology, findings, and the basis for their conclusions. 

It is also critical that your attorney ensures the IME doctor receives your complete medical records before the examination. Insurance companies sometimes provide only selected records, omitting documentation that supports your claim. An incomplete record review can lead to an incomplete, and unfavorable, medical opinion.

The Best Attorneys for Disability Claims

When an insurance company uses an IME to deny or terminate your disability benefits, you need attorneys who understand the specific tactics insurers employ and how to counter them effectively. Monahan Tucker Law focuses exclusively on disability insurance claims and life insurance disputes, representing policyholders against major insurance carriers across the West Coast and beyond.

Monahan Tucker Law handles ERISA and non-ERISA disability claims at every stage, from initial claims review and appeals through federal court litigation. The firm’s practice areas include disability insurance claims review and management, disability appeals, disability insurance litigation, life insurance litigation, disability and life insurance bad faith litigation, and related issues affecting executives and business owners.

Monahan Tucker Law’s track record includes federal court victories like Hamilton v. Prudential Insurance Co. in the Western District of Washington, among other successful outcomes for clients whose claims were wrongfully denied. Ms. Monahan Tucker is recognized as a Super Lawyer in Insurance, an accolade provided by Thompson Reuters, and as a Best Lawyer for insurance litigation, each limited to the top 5% of attorneys nationwide, and recognized as an AV Preeminent attorney by Martindale-Hubbell, a rating provided by judges and other attorneys based on legal ability, and limited to less than 5% of attorneys. 

If your insurer has scheduled an IME or has already used an IME report to deny or terminate your benefits, the attorneys at Monahan Tucker Law can review your case, ensure your medical records are complete and properly presented, and build a strategy to challenge any unfair findings. Request a consultation today to discuss your options.

Frequently Asked Questions

1: Can I refuse to attend an independent medical examination?

In most cases, no. The majority of disability insurance policies include a cooperation clause that gives the insurer the right to require an IME. Refusing to attend typically gives the insurer grounds to suspend or deny your benefits immediately, regardless of how strong your medical evidence may be. The insurer is required to locate a physician within a reasonable distance of your home, but a “reasonable” distance will differ depending on the remoteness of your home location and the difficulty in identifying a specialist in your area.  It is not uncommon for patients who live several hours from a large city to have to travel to that city for the IME. However, it is not reasonable for the insurer to make you travel overnight, or to travel for hours if you already live in an area with numerous physicians.  It is appropriate in those situations to push back and demand a reasonable IME location. You may also be able to push back if your IME physician refuses to allow an observer, unless the IME is for cognitive testing or mental health evaluation. If the IME is several hours away and there is no other reasonable location, you can require the insurer to provide transportation.

2: How long does a typical IME appointment last?

Most IMEs for physical conditions will last 30 minutes to an hour,  though some may take longer depending on the complexity of the condition being evaluated. A neuropsychological evaluation or functional capacity evaluation may take several hours.  These appointments produce reports that carry as much or more weight in claim decisions as years of treatment records from your own physicians. The insurer can and will rely on them to override the opinions of your own doctors.

3: Can I record my IME appointment?

Recording rules vary by state. In some jurisdictions, you have the right to audio or video record the examination. In others, you may need the examiner’s consent. In Washington, Oregon, and California, two-party consent is required, which means you cannot record without the consent of the physician. In Arizona, you may record without the consent of the other party.  In Nevada, you may record any in-person interactions without the consent of the other party, but not anything in a phone call or zoom call. Your attorney can advise you on the rules that apply in your state and whether recording is recommended for your specific situation.

You can require an observer in most IME appointments, unless the appointment involves cognitive or mental health testing. If the physician refuses to allow an observer, you can require the insurer to identify an IME physician who will allow it. That observer can take notes which can be submitted as part of the claim.

4: What should I do if the IME report contradicts my treating doctors?

If the IME report is the basis for denying or terminating your disability claim, you will be able to request a copy of your claim file, and the IME report will be included in that file. At that point, you will be required to appeal the denial or termination, and it will be important to retain counsel for that process. Time is often limited, especially in ERISA-governed claims where appeal deadlines can be strict. It is important to immediately review the IME report for factual inaccuracies.  Does it correctly report what you told the doctor? Does it include all the information you provided, or does it selectively omit information that supports disability? Did the IME doctor review and rely on your own doctors’ notes? 

In the appeal process, your attorney will provide the IME report to your treating physicians and obtain their rebuttals to the report. You should obtain additional testing to refute the damaging IME report, including your own truly independent IME from a doctor not paid by the insurance industry. Your attorney will research the IME doctor and highlight any issues with credentialing or background..

5: Does the insurance company have to share the IME report with me?

No. While most insurers will share the report upon request, they are not required to do so. They only have to share it if they deny or terminate your claim.  If your insurer refuses to share it, ask your treating provider to request a copy of it. They will usually share the report with the treating provider. Reviewing the report is essential so you and your attorney can identify inaccuracies, incomplete analysis, or conclusions that lack a proper medical foundation. 

6: Are IME doctors truly independent?

No. The insurance company uses a third-party vendor to hire and pay the doctor, and frames the questions the doctor is asked to answer. The third party vendor has a regular line-up of physicians who provide these evaluations for insurance companies and understand that if their reports do not align with the insurer’s preferred narrative, they will not be selected to provide more evaluations. If the answers do not fully support the insurer’s preferred narrative, the insurer sends follow-up questions designed to re-direct the physician to the desired responses. Physicians who repeatedly produce reports favorable to insurers are more likely to continue receiving referral business. Most of the physicians who engage in the process of providing paid reports receive much of their income, often most or all of their income, through the provision of these reports.  While some IME doctors do provide balanced assessments, the financial incentive structure creates an inherent conflict of interest.