Independent Medical Exams (IMEs): Your Rights During Insurer Exams

If you’re pursuing long-term disability (LTD) benefits in Pennsylvania, you may eventually receive a notice to attend an Independent Medical Exam (IME). Despite its name, this exam is rarely as neutral as it sounds. Insurance companies often order IMEs to “verify” your condition, but in practice, they’re used to find evidence that limits or discredits your claim.

For many claimants, that letter can trigger anxiety. You’ve already endured months of doctor visits, tests, and pain, only to be told that an insurer-selected physician will now decide whether you’re truly disabled. What you say, how you move, and even how long you wait in the lobby may be noted and interpreted.

That’s why understanding your rights, your preparation, and your post-exam options is critical. With the right approach, you can protect yourself from biased interpretations and ensure that the record reflects the truth about your medical limitations.

This guide explains what IMEs are, what to expect, how to prepare, and what to do if your report is inaccurate or hostile.

What Is an Independent Medical Exam (IME)?

An Independent Medical Exam is a medical evaluation requested by your insurance company, employer, or sometimes a third-party administrator to assess your condition. The goal is to obtain an objective opinion about your health status and work capacity.

However, unlike your treating doctor, the IME physician is paid by the insurer, not by you. This creates an inherent conflict of interest. The examiner’s findings can directly influence whether your benefits continue or get cut off.

An IME might be requested in any of the following cases:

• Long-term disability (LTD) claims under private or employer policies (including ERISA plans).
• Workers’ compensation claims involving extended medical treatment or disputed disability.
• Personal injury lawsuits where damages for pain and suffering are in question.

In LTD claims especially, the insurer might say the IME is a “routine review.” In truth, it often signals that they are questioning your medical evidence or preparing to deny or terminate benefits.

What to Expect During the Exam

An IME is typically scheduled at a time and place convenient for the insurer, often at a doctor’s office familiar with handling insurance evaluations. Expect the exam to last anywhere from 15 minutes to over an hour, depending on the type of condition being reviewed.

Here’s what usually happens:

1. Review of Medical Records: The examiner may have your claim file, medical reports, or test results.
2. Interview: They may ask about your medical history, current symptoms, medications, and daily activities.
3. Physical Examination: The doctor might test range of motion, strength, reflexes, or endurance.
4. Observation: Be aware that even informal moments, like walking from the waiting room or removing your jacket, can be noted and included in the report.

The examiner’s impressions will then be sent to the insurance company, often in the form of a narrative report stating whether your symptoms match your claimed disability level.

Your Rights Before and During the IME

Many claimants don’t realize that they have rights and boundaries during an insurer’s medical exam. You’re not required to surrender control of your personal dignity or accept an unfair process.

Here’s what you can assert:

1. You Have the Right to Notice and Details

You should receive written notice including:

• The doctor’s name and specialty
• The exam’s purpose
• The time and location
• What records will be shared

If anything seems unclear or suspicious, such as a change in location or a physician outside your specialty, your attorney can request clarification or rescheduling.

2. You Have the Right to Bring a Witness

In Pennsylvania, you generally may bring a neutral observer or even record the exam (depending on insurer policy and case law). This can help protect against misreporting. If your insurer objects, your lawyer can negotiate terms for observation or documentation.

3. You Have the Right to Stop if It Becomes Unsafe

You do not have to endure movements or physical tests that cause severe pain or risk of injury. Calmly explain that the action exceeds your medical tolerance and ask that your response be noted.

4. You Have the Right to Accurate Reporting

You can later request a copy of the examiner’s report. If the insurer uses it to make a decision, they must provide it upon request under ERISA and Pennsylvania insurance law. Review it carefully for misquotes, missing context, or bias.

How to Prepare for an IME

Preparation is the best defense. Treat the exam seriously, as everything you do and say may be evaluated later.

1. Review Your Medical History.

Know your diagnoses, symptoms, and medication list. Review what your treating doctors have already said about your restrictions and limitations.

2. Be Consistent and Honest.

Don’t exaggerate, but don’t minimize either. Describe your condition as you experience it daily. If pain fluctuates, explain that. For instance, “Some days I can stand for 20 minutes, but other days I can barely make it across the room.”

3. Take Notes Beforehand.

Write down your typical day: what activities cause pain, what movements you can or cannot do, and how symptoms impact your routine. This will help you give consistent, clear answers during the IME.

4. Bring Documentation.

Bring your ID, the exam notice, a list of medications, and any assistive devices (like braces, canes, or hearing aids) that you normally use.

5. Be Aware of Observation.

You may be watched from the moment you arrive. Move naturally, but avoid unnecessary physical exertion (like opening heavy doors or rushing).

After the IME: Your Post-Exam Action Plan

Once the exam ends, your part isn’t over. The real work begins after you leave the office.

1. Write a Post-IME Summary Immediately

Within a few hours, jot down your recollection of:

• How long the exam lasted
• What tests or questions were performed
• Any unusual or inappropriate behavior by the doctor
• Any statements made about your condition

This contemporaneous record can be vital if your attorney needs to challenge the IME later.

2. Notify Your Attorney or Claim Representative

Tell your attorney how the exam went and provide your notes. They may anticipate insurer action based on the IME and can begin preparing a response.

3. Request a Copy of the Report

Under ERISA, claimants are entitled to review all medical opinions used to make a benefits determination. Your lawyer can submit a written request to the insurer for the IME report and any related correspondence.

4. Compare and Correct

If the IME misstates facts, such as saying you denied symptoms you never discussed, prepare a written rebuttal with your attorney’s help. You may also submit:

• A correction letter explaining inaccuracies
• A treating doctor’s statement clarifying your true limitations
• Supplemental medical evidence, like imaging or lab results that contradict the IME findings

5. Document Post-Exam Effects

If you experience increased pain, fatigue, or injury after the IME, seek medical attention and have it documented. This can counter claims that the tests were harmless or that your condition has improved.

Red Flags in IME Reports

Insurers sometimes rely on IMEs filled with loaded language designed to undermine credibility. Watch for terms like:

• “Symptom magnification”
• “Inconsistent effort”
• “Malingering behavior”
• “No objective evidence of impairment”

Often, these labels ignore legitimate pain responses or conditions that fluctuate in severity (like fibromyalgia or neurological disorders). Your attorney can challenge these conclusions by comparing them with long-term treatment records and objective data.

When an IME Threatens Your LTD Benefits

A negative IME report doesn’t have to end your claim. Under Pennsylvania and federal ERISA law, you have a right to appeal any termination or denial and to present counter-evidence.

A skilled LTD attorney can obtain the IME’s raw data and notes to identify inconsistencies, gather rebuttal letters from your treating specialists, expose procedural unfairness such as lack of specialty alignment or inadequate exam duration, and build a comprehensive appeal file that accurately reflects your disability.

Protect Your Disability Benefits: Contact Edelstein Martin & Nelson

An IME can make or break your long-term disability case, but you don’t have to face it alone. The insurer’s doctor may be paid to question your credibility, but your truth is backed by evidence, and you have the right to defend it.

At Edelstein Martin & Nelson, our Philadelphia long-term disability lawyers have decades of experience handling biased IMEs and insurer tactics. We prepare clients before exams, attend when possible, and challenge flawed medical opinions with powerful, evidence-based responses.

If you’ve been scheduled for an IME, received a hostile report, or had your benefits cut off because of one, don’t wait for the insurer to dictate your future. Call (215) 731-9900 today for a free consultation. Let us help you protect your rights, correct the record, and fight for the disability benefits you’ve earned.