If your long-term disability insurer asks you to attend an independent medical examination in Ontario, take the request seriously. An IME is often requested when the insurer is deciding whether to approve, continue or cut off your benefits.
An independent medical examination—also called an IME, independent medical assessment or independent medical evaluation—is arranged to give the insurance company another opinion about your health and ability to work.
The insurer normally chooses the doctor, sends them medical and claim information, asks the questions they want answered, pays for the assessment and receives the report.
The doctor must follow professional rules in Ontario, but they aren’t your treating doctor. The examination is being done for your insurance claim—not to provide you with medical care.
For a broader overview, read our national guide to independent medical examinations and LTD claims.
On This Page:
- What Is an IME?
- Why Insurers Request IMEs
- Can Benefits Be Cut Off?
- Ontario IME Rules
- Do You Have to Attend?
- How to Prepare
- Recording and Support People
- If the Report Is Wrong
What Is an Independent Medical Examination in Ontario?
An independent medical examination is an assessment done for a third party, such as a disability insurance company, rather than for your treatment.
The doctor can review your medical records, ask about your symptoms and daily activities, examine you and assess how your condition affects your ability to work.
They then prepare a report for the insurer. That report can become important evidence in deciding whether you qualify for long-term disability benefits.
Why Do Insurance Companies Request an IME?
An insurer requests an IME when it wants another medical opinion about whether you meet the LTD policy’s definition of disability.
An IME is commonly requested:
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While your initial LTD application is being reviewed
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When the insurer disagrees with your treating doctor
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When the insurer believes your condition has improved
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Before a proposed return to work
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Around the two-year change from “own occupation” to “any occupation”
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When the insurer is considering cutting off your benefits
The doctor can be asked whether your symptoms are supported by the medical evidence, what your condition prevents you from doing and whether you can return to your own job or another occupation.
Can an IME Lead to Your LTD Benefits Being Cut Off?
Yes. An insurance company can use an IME report to deny an LTD application or cut off benefits that are already being paid.
For example, the doctor might say that:
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Your symptoms don’t prevent you from working
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Your condition has improved
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Your condition limits you less than your treating doctor says
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You can return to your previous job
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You can perform another suitable job
The insurer can rely on those conclusions even when your own doctors continue to say that you can’t work.
However, an IME report isn’t automatically more reliable than the evidence from your treating doctors. If the report gets the facts wrong or reaches conclusions that aren’t supported by the medical evidence, it can be challenged.
What Rules Apply to IME Doctors in Ontario?
Doctors conducting IMEs in Ontario are regulated by the College of Physicians and Surgeons of Ontario.
An Ontario IME doctor must:
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Stay within their area of medical expertise
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Disclose relevant conflicts of interest
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Explain that they aren’t acting as your treating doctor
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Get the required consent
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Review relevant medical information
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Provide an objective opinion supported by the medical information
Is the IME Doctor Truly Independent?
The doctor must give an objective medical opinion, but the insurer still controls important parts of the process.
The insurer normally chooses and pays the doctor, decides what records to send, asks the questions and receives the final report.
That doesn’t automatically mean the report is unfair or wrong. However, if the insurer later relies on the report to cut off your benefits, it is important to look closely at what the doctor was asked, what information they received and how they reached their conclusions.
Do You Have to Attend an LTD IME in Ontario?
You generally have to attend a reasonable IME when your LTD policy gives the insurer the right to request one.
Refusing can result in delayed, suspended or terminated benefits.
However, an insurer’s right to request an examination isn’t unlimited. Concerns can arise when:
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The doctor’s specialty doesn’t match your condition
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The insurer keeps sending you for repeat examinations that cover the same ground
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The testing could make your condition worse
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Travel or the length of the appointment creates a medical problem
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The insurer refuses an accommodation you need because of your disability
Raise concerns in writing and ask your treating doctor to support you where appropriate. Don’t simply miss the appointment.
What Information Does the IME Doctor Receive?
The insurer normally chooses the information sent to the doctor. This can include:
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Medical records and specialist reports
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Diagnostic test results
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Your LTD application
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Your job description
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Previous medical or functional assessments
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Surveillance or other claim information
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The questions the insurer wants the doctor to answer
Ask the insurer for the letter sent to the doctor and a list of the records provided. If important medical information is missing, identify it before the appointment.
How Should You Prepare for an Ontario IME?
Confirm the Details
Ask the insurer to confirm the doctor’s name and specialty, why the examination is being requested, how long it is expected to take, what testing is involved and what you need to bring.
Review Your Medical History
Be familiar with your major diagnoses, treatments, medications and changes in your symptoms. You don’t need to memorize every date. If you don’t remember something, say so instead of guessing.
Understand Your Job Duties
Be prepared to explain what your job actually requires and which duties your condition prevents you from doing safely and consistently.
Request Accommodations Early
Tell the insurer in advance if you need rest breaks, an accessible location, an interpreter, a shorter assessment or help with travel. Ask your treating doctor to support the request if needed.
During the Examination
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Answer questions honestly
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Don’t exaggerate or minimize your symptoms
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Explain good days, bad days and how long it takes you to recover after activity
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Ask for clarification if you don’t understand a question
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Tell the doctor if testing causes pain, fatigue, dizziness, panic or another significant symptom
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Don’t push yourself beyond what is safe
Can You Record an IME or Bring Someone With You?
Recording the Examination
If you want to record the IME, raise the issue with the insurer and doctor before the appointment.
Ontario professional rules require the recording arrangement to be acceptable to everyone involved. Recording can also interfere with some psychological or cognitive testing.
Don’t secretly record the examination. If recording isn’t allowed, write down what happened as soon as the appointment is over.
Bringing an Observer or Support Person
You can ask to bring an observer or support person. Ontario doctors generally allow one unless they believe the person’s presence will affect the examination.
Make the request in advance, especially if you need support because of memory problems, communication difficulties, anxiety, trauma, mobility issues or another medical concern.
Psychological, Psychiatric and Other LTD Assessments
An IME can focus on a physical or mental health condition.
A psychologist can assess issues such as anxiety, depression, memory, concentration and thinking ability. A psychiatrist can provide medical opinions about your diagnosis, medication, treatment and ability to work.
Mental health IMEs can involve personal questions about your medical history, family life, relationships and past experiences. Those questions should still relate to the purpose of the assessment.
Functional Capacity Evaluation
A functional capacity evaluation, or FCE, tests your ability to perform physical or cognitive tasks. Read our guide to functional capacity evaluations in Canada.
Vocational Assessment and TSA
A vocational assessment looks at your education, training and work history to identify other jobs the insurer says you can perform.
A transferable skills analysis, or TSA, is one tool insurers use for this purpose, particularly when the LTD policy changes to the “any occupation” test.
What Should You Do After the IME?
As soon as possible after the appointment, write down:
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When the examination started and ended
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The main questions you were asked
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The tests or movements you were asked to perform
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Any breaks you needed
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Symptoms you experienced during or after the assessment
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Anything important the doctor said
Ask the insurer for the complete IME report—not just a summary of what the doctor concluded.
What if the Ontario IME Report Is Wrong?
An IME report can be challenged if it gets the facts wrong or reaches conclusions that aren’t supported by the medical evidence.
Problems can include:
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The report says you made comments that you didn’t make
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It describes the examination incorrectly
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Important symptoms or limitations are left out
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Important medical records weren’t reviewed
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The doctor gives an opinion outside their area of expertise
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The report treats one brief activity as proof that you can work all day, every day
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It doesn’t account for symptoms that come and go or the recovery time you need after activity
Get the complete report, compare it with your notes and ask your treating doctor or specialist to review the conclusions.
If the insurer uses the IME to deny or cut off your benefits, speak with an Ontario disability lawyer before responding.
Read what to do after a long-term disability denial in Ontario.
When Should You Contact an Ontario LTD Lawyer?
Get advice before the IME if the insurer is reviewing your benefits, the assessment is scheduled near the two-year change of definition, the doctor’s specialty doesn’t seem appropriate or the insurer refuses an accommodation you need.
Get advice immediately afterward if:
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The report contains serious errors
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The insurer pressures you to return to work
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Your benefit payments are stopped
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Your LTD claim is denied or your benefits are cut off
An Ontario long-term disability lawyer can review your policy, the questions the insurer asked the doctor to answer, the IME report and your medical evidence and explain how to protect your benefits.
Frequently Asked Questions About Ontario IMEs
Why Is My LTD Insurer Sending Me for an IME?
The insurer wants another medical opinion about your condition and ability to work. An IME is often requested while the insurer is deciding whether to approve, continue or cut off your benefits.
Can My Ontario LTD Insurer Require Me to Attend?
Yes, if your LTD policy gives the insurer the right to request a reasonable examination. Refusing can put your benefits at risk.
Can I Record the IME?
You can ask to record it, but the arrangement must be agreed to in advance. Don’t secretly record the examination.
Can I Bring Someone With Me?
You can request an observer or support person. The doctor generally allows one unless they believe the person’s presence will interfere with the assessment.
Can I Get a Copy of the IME Report?
Ask the insurer in writing for the complete report. Don’t rely only on the insurer’s summary of what the doctor said.
What Happens if the IME Doctor Says I Can Return to Work?
The insurer can use that opinion to deny or cut off your LTD benefits. The report can be challenged if it gets the facts wrong or isn’t supported by the medical evidence.
Get Help With an Independent Medical Examination in Ontario
An IME can become a turning point in your long-term disability claim.
Don’t treat it as a routine doctor’s appointment or wait until the insurer uses the report to cut off your income.
Samfiru Tumarkin LLP represents people with denied, delayed and terminated long-term disability claims throughout Ontario.
Our disability lawyers can review the assessment request, help you prepare and challenge an inaccurate report.
Contact us for a free consultation if you have been asked to attend an IME or your benefits were denied after one.