If you are receiving long-term disability (LTD) benefits in Ontario, your insurance company may require you to attend an Independent Medical Examination (IME). In many cases, an IME is not just a routine step in your claim. It is often a turning point where the insurance company gathers evidence to support a decision to reduce or terminate your benefits.
Despite being described as “independent,” these examinations are arranged and paid for by the insurer. The doctor’s report can have a significant impact on whether your benefits continue. Understanding how IMEs work, what to expect, and how they may affect your claim is critical to protecting your rights.
If you have been asked to attend an IME or are concerned about how it may affect your benefits, it is important to get advice before moving forward.
Speak with a long term disability lawyer about your LTD claim. We offer a free 30-minute phone consultation. Call 416-907-9249 or complete our contact form to get started.
What Is an Independent Medical Examination (IME)?
An Independent Medical Examination (IME) is an assessment arranged by your insurance company to evaluate your medical condition and your ability to work. The insurer selects a doctor or specialist to review your condition, ask questions, and provide a report. This report is often used by the insurance company to decide whether:
- you continue to qualify for disability benefits
- your condition has improved
- you are capable of returning to work
Although described as “independent,” the doctor is typically chosen and paid by the insurance company.
Why Do Insurance Companies Request an IME?
Insurance companies frequently request IMEs as part of reviewing or reassessing your claim.
This often happens:
- before approving benefits
- when benefits have been ongoing for a period of time
- at the change of definition stage, usually around 24 months
- when the insurer is considering denying or terminating your benefits
In many cases, the IME is used to support a decision to reduce or cut off benefits.
How IMEs Are Used to Deny Long-Term Disability Claims
In many long-term disability claims, an IME is used by the insurance company to support a decision to deny or terminate benefits.
While the examination may appear neutral, the insurer controls the process, including which doctor is selected and what information is provided in advance.
In some cases:
- the insurer relies on brief observations made during a single assessment
- the report may focus on isolated statements or activities
- important medical history from your treating doctors may be minimized or overlooked
- the IME is requested shortly before the insurer issues a denial or termination letter.
This can result in conclusions that differ from the opinions of your own physicians, particularly where your condition is complex or fluctuating. Understanding how IMEs are used can help you better prepare and protect your claim.
Who Chooses the IME Doctor?
The insurance company selects the doctor who will perform the examination. You generally do not get to choose the assessor. This is important because:
- the doctor is being paid by the insurer
- the insurer controls the referral and information provided
- the report is prepared for the insurer’s use
Doctors performing IMEs in Ontario are generally regulated by the College of Physicians and Surgeons of Ontario, which sets professional standards for medical practice. This creates a concern that the process may not be fully neutral.
What Happens During an IME?
The IME typically includes:
- a review of your medical records
- questions about your symptoms and daily activities
- a physical or psychological assessment
- questions about your work history and abilities
The assessment is not treatment. The purpose is to evaluate your condition for the insurer. After the exam, the doctor prepares a report that is sent to the insurance company.
Are IMEs Biased?
Many claimants are concerned about bias in IMEs.
While IMEs are presented as independent, insurers often rely on a small group of assessors who regularly perform examinations for them.
This can raise concerns that:
- the assessment may favour the insurer’s position
- the report may minimize your symptoms
- important medical evidence may be overlooked
IME reports can play a key role in decisions to deny or terminate benefits, even when your treating doctors disagree.
Do You Have to Attend an IME?
In most cases, your disability policy requires you to attend an IME if requested.
If you refuse, the insurance company may:
- suspend your benefits
- deny your claim
- argue that you are not cooperating
However, there may be limits on what the insurer can request.
For example, the request may be unreasonable if:
- the location is too far or inaccessible
- the type of exam is not relevant to your condition
- you are medically unable to attend
It is important to get legal advice before refusing an IME.
How to Prepare for an IME
Preparing properly can make a significant difference.
You should:
- be honest and consistent about your symptoms
- describe your limitations accurately
- avoid exaggerating or minimizing your condition
- be prepared to explain what a typical day looks like
- review your medical history before the appointment
Everything you say and do during the IME may be included in the report.
What Happens After the IME?
After the examination, the doctor will prepare a written report.
The insurance company will use this report to decide whether to:
- continue your benefits
- reduce your benefits
- deny or terminate your claim
In many cases, a negative IME report is followed by a denial letter. If this has happened to you, see what to do if your long-term disability claim is denied.
Can You Challenge an IME Report?
Yes. IME reports can be challenged.
If the report is inaccurate or unfair, you may be able to:
- provide rebuttal medical evidence from your treating doctors
- identify errors or inconsistencies in the report
- challenge the insurer’s decision through a legal claim
Courts do not automatically accept IME opinions, especially where they conflict with strong medical evidence. You can learn more about your legal options on our long-term disability page.
When Should You Speak to a Long Term Disability Lawyer About an IME?
You should consider speaking with a lawyer if:
- you have been asked to attend an IME
- your benefits were denied after an IME
- the IME report does not reflect your condition
- you are unsure how to respond to the insurer
Early legal advice can help you avoid mistakes and protect your claim.
Frequently Asked Questions About IMEs and LTD Claims
What is an independent medical examination in a disability claim?
An independent medical examination is an assessment requested by an insurance company to evaluate your medical condition, restrictions, and ability to work. In long-term disability claims, the insurer often uses the IME to decide whether your benefits should continue.
Who chooses the doctor for an IME?
In most cases, the insurance company chooses the doctor or assessor. The claimant usually does not get to select the examiner.
Do I have to attend an IME for long-term disability?
Often, yes. Many disability policies require claimants to attend reasonable medical assessments requested by the insurer. Refusing may lead to a suspension or denial of benefits, although some requests can be challenged if they are unreasonable.
Can an IME be biased?
Yes, bias can be a concern. Although the exam is described as independent, the doctor is usually chosen and paid by the insurer, which can raise fairness concerns in some cases.
What happens if my LTD benefits are denied after an IME?
If your LTD benefits are denied after an IME, you may still be able to challenge the decision. This can include providing updated medical evidence, responding to inaccuracies in the report, and pursuing a legal claim if necessary.
Contact an Ontario Long Term Disability Lawyer
If your long-term disability benefits were denied after an Independent Medical Examination, you may still have options. We help employees challenge disability claim denials and deal with insurance companies. Contact us for a free 30-minute phone consultation.
Contact an Ontario Long Term Disability Lawyer
If your long-term disability benefits were denied after an Independent Medical Examination, you may still have options. Insurance companies often rely on IME reports to justify denying or terminating benefits, even where your treating doctors disagree. We help employees challenge disability claim denials and deal with insurance companies. Contact us for a free 30 minute phone consultation.