The Insurer Wants an “Independent” Medical Exam. Should I Go?

Your insurance company has sent you a letter: they want you to attend an “Independent” Medical Exam (IME). Does this feel like they are questioning your doctor and your own experience? It is a common feeling, and the simple answer to whether you should go is almost always yes. Most long-term disability policies give the insurer the right to request this exam, and refusing can lead to an immediate denial of your claim. However, understanding what an IME truly is and how to prepare is crucial to protecting your rights and your benefits.

Why Does the Insurer Want an IME?

When you file a disability claim, you provide medical records from your own doctors. An IME is the insurance company’s opportunity to have a doctor of their choosing evaluate your condition. They request these exams when they want to challenge your doctor’s opinion, question the severity of your limitations, or find a reason to deny or terminate your benefits. It is important to remember that the doctor performing the IME is not on your side; they are paid by the insurance company, and their report will heavily influence the outcome of your claim.

What Are the Risks of Attending or Refusing?

Navigating an IME request is a critical moment in your claim. Understanding the consequences of your decision is essential.

• Refusing the Exam: If your policy requires you to attend an IME, refusing to go is a breach of your contract with the insurer. This will almost certainly result in the termination of your benefits, and it will be very difficult to fight that decision later.
• Attending the Exam: The primary risk of attending is that the IME doctor will issue a report that contradicts your medical evidence. They may conclude that your condition is not as severe as you claim or that you are capable of working, giving the insurer the ammunition it needs to deny your benefits.

How Should I Prepare for the Exam?

Since you likely must attend, preparation is key. You are not powerless in this situation. Taking control of the process can make a significant difference.

• Be Honest and Consistent: Describe your symptoms and limitations accurately. Do not exaggerate, but also do not downplay your pain or difficulties. Your description should be consistent with what you have told your own doctors and reported to the insurer.
• Document Everything: Keep a record of how long the exam lasts, what questions were asked, and which physical tests were performed. The exam itself may be surprisingly brief, sometimes lasting only 15-20 minutes.
• Bring a Witness: If possible, have a trusted friend or family member accompany you to the exam to observe and take notes.
• Know Your Rights: You are not required to fill out extensive new paperwork at the IME office or discuss the details of your claim. The exam is for a physical or psychiatric evaluation only.

The request for an IME can be a stressful and intimidating part of the disability claim process. It often signals that the insurance company is looking for a way to deny your claim. You do not have to face this challenge alone. At Monahan Tucker Law, we can help you prepare for the exam, ensure your rights are protected, and fight back if the insurer uses a biased IME report against you. Contact us today for a confidential consultation.