An Independent Medical Examination is rarely as neutral as it sounds. It is a medical evaluation requested by your insurance company, performed by a doctor they select and pay, designed to generate a report that often becomes the centerpiece of a claim denial. The examining physician has a financial relationship with the insurer—not with you. And that one brief appointment, which may last as little as 15-20 minutes, can be given more weight than years of treatment records from physicians who actually know your condition.
If you have been scheduled for an IME or are facing a claim denial based on an IME report, the disability insurance attorneys at Kantor & Kantor, LLP can help you understand your rights, prepare strategically, and challenge biased findings that do not reflect the reality of your limitations.
We have guided countless California claimants through this intimidating process, and we know how to protect yourinterests when the insurance company’s interests are clearly at odds with your own.
Don’t face this alone. Schedule a free, confidential case evaluation online or at 818-886-2525 to discuss your situation and explore your options.
Why Legal Representation Matters for Independent Medical Examinations
IMEs carry enormous weight in disability claims, often more than they should.
- “Independent” is a Misleading Term: There is nothing independent about an IME. The insurance company selects the doctor, pays the doctor, and maintains an ongoing business relationship with that doctor. Many IME physicians conduct hundreds of evaluations for insurers annually, generating significant income from these referrals. That financial incentive creates an inherent conflict of interest, and research consistently shows that IME doctors find against claimants at rates far higher than treating physicians.
- You Are Required to Attend: Your disability policy almost certainly contains a “cooperation clause” that obligates you to attend any IME the insurer requests. Refusing to go or failing to appear can result in immediate termination of your benefits, regardless of how legitimate your claim may be. The insurance company knows this gives them tremendous leverage.
- The IME Report Often Overrides Your Treating Physicians: The independent physician or nurse, who will spend only a short time with you, who has no prior knowledge of your condition, who will not provide any treatment or follow-up care, can produce a report that the insurance company will cite as more credible than the opinions of specialists who have treated you for months or years. IME reports frequently become the primary—sometimes sole—basis for claim denials, even when they directly contradict extensive medical records.
What is the Purpose of an IME?
Insurance companies often request an IME to evaluate a disability claim. While the stated purpose is to confirm your diagnosis, assess the severity of your condition, and determine whether your limitations prevent you from working, these exams often serve other functions:
- Manufacturing Contradictory Evidence: Your treating physicians have documented your disability with detailed records, diagnostic tests, functional assessments, and treatment notes spanning months or years. The IME doctor will spend a fraction of that time with you and produce a report that questions or outright contradicts those findings.
- Hunting for Inconsistencies: IME doctors are trained to look for any discrepancy between what you report, what is in your medical records, and what they observe during the brief examination. Did you mention you cannot sit for long periods, but you sat through a 30-minute exam? Did you say you have trouble walking, but you walked from your car without visible difficulty? These “inconsistencies”—which do not account for good days versus bad days, the effects of medication, or the fact that you might push through pain for important appointments—become weapons against your claim.
- Minimizing Your Limitations: IME reports often characterize legitimate impairments as “subjective complaints” rather than objective findings. If your disability stems from pain, fatigue, cognitive difficulties, or other symptoms that cannot be measured by medical equipment, IME doctors frequently dismiss these as unverifiable or exaggerated.
- Creating a Paper Trail for Litigation: Insurance companies know that many denied claims never get appealed and even fewer reach litigation. But when they do, the IME report becomes part of the administrative record. Under ERISA (which governs most employer-provided disability plans), courts review denials based almost entirely on what is in that record. A negative IME report is often the cornerstone of the insurer’s defense.
These examinations may not always be done with the altruistic intent to support your claim, pay maximum benefits under the policy, or facilitate a hassle-free legal process. Instead, they often serve as a tool for insurers to gather information that may justify a denial.
How to Handle an Insurance Company Medical Assessment
The IME report will be added to your claim file, and there is a strong likelihood the insurance company will use it as the basis for denying or terminating your benefits. When that happens, you need to act quickly.
Request a copy of the IME report as soon as it is completed. Review it carefully for:
- Factual inaccuracies (misstatements about your work history, medical history, or symptoms)
- Mischaracterizations of what you said during the examination
- Omissions of important information you provided
- Conclusions that aren’t supported by the examination findings
- Reliance on outdated medical literature or flawed reasoning
- Failure to consider the opinions of your treating physicians.
Do not let a biased IME report go unchallenged. Your attorney can help you:
- Obtain detailed rebuttal letters from your treating physicians that directly address the IME doctor’s conclusions
- Secure additional medical testing or functional capacity evaluations that document your limitations objectively
- Commission your own independent medical evaluation from a qualified specialist without ties to the insurance industry
- Present vocational evidence showing how your limitations prevent you from performing your occupation (or any occupation, depending on your policy)
- Highlight the IME doctor’s lack of specialty training in your particular condition.
Sometimes the IME process itself is conducted improperly, giving you additional grounds to challenge the insurer’s actions:
- The insurer scheduled multiple IMEs without justification
- The IME doctor lacks appropriate credentials or specialty training for your condition
- The examination was unreasonably brief given the complexity of your case
- The insurer refused to allow recording or a witness despite California law
- The IME report was clearly prepared using a template, with minimal individualized assessment
- The doctor has a documented history of always finding against claimants.
These procedural violations can strengthen your case and may even constitute bad faith on the part of the insurance company.
Let Kantor & Kantor, LLP Help Protect Your Rights During an Independent Medical Examination
At Kantor & Kantor, LLP, we know the doctors insurers prefer to use, the tactics they employ, and the language that shows up in reports designed to deny claims. More importantly, we know how to prepare you to protect yourself and how to dismantle a biased IME report when it is used against you. We are people helping people, and we look forward to helping you.
Do not face a denial as a result of an Independent Medical Examination alone. The time to act is now. Contact Kantor & Kantor, LLP online or at 818-886-2525 for a free, confidential consultation.
