If your long-term disability insurer asks you to attend an independent medical examination, assume that your eligibility for benefits is being closely reviewed.
An independent medical examination—commonly called an IME, independent medical assessment or independent medical evaluation—is arranged to give the insurance company another opinion about your condition and ability to work.
The examination isn’t medical treatment. The doctor or assessor isn’t there to diagnose you for your benefit, recommend treatment or advocate for you.
The insurer chooses the assessor, provides the assessment instructions and pays for the report. That report can then be used to approve, continue, deny or terminate your LTD benefits.
On This Page:
- What Is an IME?
- Do You Have to Attend?
- Is the Doctor Independent?
- Types of Assessments
- How to Prepare
- During the Examination
- Recording and Support People
- After the IME
- FCEs, TSAs and Vocational Assessments
- Provincial IME Information
What Is an Independent Medical Examination?
An independent medical examination is an assessment performed by a doctor or other professional who isn’t part of your treating medical team.
The insurance company normally requests the assessment to obtain an opinion about:
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Your diagnosis and symptoms
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Your medical restrictions and functional limitations
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Whether your condition prevents you from working
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Whether your treatment has been appropriate
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Whether your condition has improved
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Whether you can return to your own occupation
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Whether you can perform another occupation
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Whether further treatment, rehabilitation or testing is recommended
The assessor prepares a report for the insurance company after reviewing the available records and examining or interviewing you.
Why Do LTD Insurers Request IMEs?
Insurance companies request IMEs when they want additional evidence about whether you meet the LTD policy’s definition of disability.
An IME commonly takes place:
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Before the insurer makes an initial decision
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During an ongoing review of approved benefits
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When the insurer disagrees with your treating doctor
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Before a proposed return to work
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Near the two-year change from “own occupation” to “any occupation”
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Before the insurer denies or terminates benefits
An IME request doesn’t automatically mean your claim will be denied. However, it does mean the insurer is gathering evidence that can materially affect your benefits.
Treat the request seriously and get advice before attending—not after the insurer uses the report to cut off your income.
Do You Have to Attend an Independent Medical Examination?
In most LTD claims, you must attend a reasonable IME if the policy gives the insurer the right to request one.
Failing to attend can lead the insurer to:
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Suspend your benefit payments
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Deny your LTD application
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Terminate approved benefits
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Claim that you failed to cooperate with the assessment process
That doesn’t give the insurer an unlimited right to demand any assessment it wants.
Questions can arise when:
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The assessment isn’t relevant to your condition
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The assessor lacks the appropriate specialty or expertise
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The insurer requests repeated examinations without a reasonable explanation
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The location or duration creates a medical hardship
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The proposed testing could aggravate your condition
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The insurer refuses reasonable disability-related accommodations
Don’t simply tell the insurer that you refuse to attend. Raise your concerns in writing, obtain medical support where appropriate and speak with a disability lawyer.
Is the IME Doctor Truly Independent?
The examiner has a professional obligation to provide an objective opinion, but the process isn’t independent in the ordinary sense of the word.
The insurer normally:
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Selects the doctor or assessment company
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Pays for the examination
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Chooses the records sent to the assessor
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Provides the questions the assessor must answer
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Receives the final report
You usually don’t choose the assessor or participate in preparing the referral instructions.
Some doctors perform a significant volume of assessments for insurance companies. That doesn’t automatically make a report inaccurate, but it makes careful review essential.
The report should still be balanced, factually accurate, within the examiner’s area of expertise and based on the relevant medical information.
Types of Independent Medical Examinations
The insurer should select an assessor with expertise relevant to the condition being reviewed.
Physical IME
A physical IME can be performed by an orthopaedic surgeon, neurologist, physiatrist, rheumatologist or another medical specialist.
It can include questions about your symptoms, a physical examination and observations of your movement, strength, balance or range of motion.
Psychological IME
A psychologist can assess cognitive, emotional and behavioural symptoms and administer standardized psychological testing.
The assessment can examine issues such as concentration, memory, anxiety, depression, trauma symptoms and the consistency of test responses.
Psychiatric IME
A psychiatric IME is performed by a medical doctor specializing in mental health.
The psychiatrist can review your diagnosis, medication, treatment history, symptoms, daily functioning and ability to work.
Psychological and psychiatric IMEs can involve detailed questions about highly personal events. Ask about the scope, duration and purpose of the assessment before attending.
Neuropsychological Assessment
A neuropsychological assessment measures areas such as memory, attention, processing speed, language and executive functioning.
These assessments can take several hours and are often used in claims involving concussion, brain injury, neurological conditions or cognitive symptoms.
Paper or File Review
The insurer can also ask a doctor to review your medical file without examining you.
A file-review doctor provides an opinion based on the records selected by the insurer. The doctor doesn’t personally observe your symptoms or limitations.
How Should You Prepare for an IME?
Prepare carefully, but don’t rehearse answers or try to “pass” the assessment.
Get the Details in Writing
Ask the insurer to confirm:
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The assessor’s name and professional specialty
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The date, time and expected duration
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The purpose of the assessment
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The type of testing that will be performed
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Whether the appointment is in person or virtual
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What documents or identification you must bring
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What travel and attendance expenses will be covered
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Whether you will receive a complete copy of the report
Review Your Medical History
Be familiar with the major dates, treatments, medications and changes in your symptoms.
You don’t have to memorize every appointment. Say that you don’t remember when you’re genuinely unsure.
Understand Your Job Duties
Be prepared to explain what your occupation actually requires and which duties you can’t perform safely, reliably or consistently.
Take Medication Normally
Take prescribed medication as directed unless your treating doctor gives different instructions.
Request Necessary Accommodations Early
Tell the insurer in advance if you need:
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Rest breaks
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A shorter appointment
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An accessible location
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An interpreter
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Transportation assistance
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Scheduling that accounts for medication or symptom patterns
Ask your treating doctor to support medically necessary accommodations.
What Records Does the IME Examiner Receive?
The insurance company decides what materials it sends to the examiner.
The package can include:
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Medical reports and clinical notes
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Diagnostic test results
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Your LTD application forms
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Your job description
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Statements made to the adjuster
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Surveillance footage or investigator reports
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Social media information
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Previous IME or file-review reports
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Functional capacity or vocational assessment reports
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A referral letter containing questions from the insurer
Ask the insurer for a copy of the referral letter and a list of the records provided to the assessor.
If important medical information was omitted, identify it before the examination and ask that it be included.
What Should You Do During the IME?
Be Honest and Consistent
Describe your symptoms and limitations accurately. Don’t exaggerate them, but don’t minimize them to appear polite, cooperative or optimistic.
Listen Carefully to Each Question
Answer the question being asked. Ask for clarification if you don’t understand it.
Explain Variability
If your condition fluctuates, explain the difference between good days, bad days and the recovery time required after activity.
Being able to perform something once doesn’t necessarily mean you can sustain it throughout a workday or workweek.
Don’t Push Through Unsafe Symptoms
Tell the examiner immediately if testing causes pain, dizziness, fatigue, panic or another significant symptom.
Don’t continue an activity simply because you believe stopping will make you look uncooperative.
Remember That Observation Can Begin Before the Appointment
The assessor can record observations about how you arrive, sit, walk, complete forms, interact with staff and leave the office.
Behave naturally. Don’t alter your conduct because you believe you’re being watched.
Can You Record an Independent Medical Examination?
Don’t secretly record an IME.
Ask the insurer and examiner in writing whether audio or video recording will be permitted. The assessor can impose conditions or refuse to proceed if a recording interferes with the examination.
Recording can be particularly complicated when an assessment involves standardized psychological, psychiatric or neuropsychological testing.
If recording isn’t permitted:
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Write detailed notes immediately afterward
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Record when the appointment began and ended
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List the questions and tests you remember
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Describe any symptoms triggered by the assessment
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Note anything the examiner said about your condition or ability to work
Can a Support Person Attend an IME?
You can ask to have a support person attend, but their presence isn’t automatically allowed.
An examiner can refuse if they believe another person will affect the interview, testing or reliability of the assessment.
A request is stronger when a support person is needed because of:
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A cognitive or communication disability
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Severe anxiety or trauma symptoms
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Memory difficulties
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Mobility or personal-care needs
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A safety concern
Make the request in advance and provide medical support when appropriate.
A clinic-appointed chaperone or independent interpreter isn’t necessarily the same as a support person chosen by you.
Who Pays the Travel and Attendance Costs?
The insurer arranging the IME should confirm the expenses it will cover.
Ask for written approval before incurring costs for:
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Mileage or transportation
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Parking
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Hotel accommodation
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Meals during extended travel
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A medically required companion or attendant
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Accessible transportation
If the assessment location is medically difficult or unreasonably far away, don’t simply miss the appointment.
Request a closer location, virtual assessment, overnight accommodation or another reasonable arrangement. Support the request with information from your treating doctor.
What Should You Do After an IME?
Write Down What Happened
As soon as possible, record:
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The start and end time
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Who was present
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The questions that were asked
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The tests or physical movements performed
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Any breaks you requested or received
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Symptoms experienced during and after the assessment
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Statements made by the examiner
Tell Your Doctor About Significant Symptoms
Contact your treating professional if the assessment causes a serious flare-up, injury or psychological reaction.
Request the Complete Report
Ask the insurer in writing for the complete IME report and any related recommendations.
The insurer might provide the report directly to you or send it through your treating doctor.
Don’t Assume Silence Means the Claim Is Safe
Follow up if the insurer doesn’t explain how the assessment affects your claim.
What if the IME Report Misrepresents the Examination?
An IME report can be challenged when it contains factual errors, omits important information or reaches conclusions unsupported by the evidence.
Common problems include:
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Incorrect statements about what you said
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An inaccurate description of the examination
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Missing symptoms, limitations or treatment history
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Conclusions outside the assessor’s expertise
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Reliance on incomplete medical records
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Failure to account for fluctuating symptoms
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Equating a brief activity with the ability to work full time
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Ignoring the opinions of your treating professionals
Don’t send an angry or emotional response directly to the assessor.
Instead:
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Create a detailed list of every factual error and omission
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Compare the report with the notes you made immediately after the examination
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Ask your treating doctor or specialist to review the conclusions
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Obtain a medical response where appropriate
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Speak with a disability lawyer before responding to the insurer
If the insurer denies or terminates benefits based on the report, read what to do when your long-term disability claim is denied.
IME vs. FCE, Vocational Assessment and TSA
Insurance companies use several different assessments during an LTD claim. They aren’t interchangeable.
Functional Capacity Evaluation
A functional capacity evaluation, or FCE, measures your ability to perform physical or cognitive activities.
An FCE is usually conducted by an occupational therapist, physiotherapist or another trained evaluator rather than a medical specialist.
Read our complete guide to functional capacity evaluations in Canada.
Vocational Assessment
A vocational assessment examines your education, work history, experience and potential ability to perform other occupations.
It is especially common around the change from the “own occupation” test to the “any occupation” test.
Transferable Skills Analysis
A transferable skills analysis, or TSA, identifies jobs that the insurer says use skills developed through your education and previous employment.
A TSA isn’t a medical examination. It often relies on medical restrictions taken from an IME, FCE or file review.
Read more about transferable skills analyses in disability claims.
Independent Medical Examinations by Province
The basic IME process is similar across Canada because the LTD policy usually creates the insurer’s right to request an assessment.
Provincial law and professional rules still affect issues such as physician conduct, complaints, legal deadlines and court proceedings.
Independent Medical Examinations in Ontario
Ontario physicians performing IMEs must conduct assessments within their expertise and comply with professional obligations concerning consent, objectivity, reporting and potential conflicts.
Requests for an observer or recording must be addressed before the assessment and can depend on whether the physician believes they will interfere with the examination.
Learn more about independent medical examinations in Ontario.
Independent Medical Examinations in Alberta
In Alberta, an IME can also be described as a non-treating medical examination. The examiner isn’t providing treatment and is expected to remain objective and work within the scope of the insurer’s referral.
Learn more about independent medical examinations in Alberta.
Independent Medical Examinations in British Columbia
In B.C., the examiner should explain the purpose and scope of the assessment and how it differs from an ordinary medical appointment.
A personal support person isn’t automatically permitted. The physician can instead use a clinic-appointed chaperone or independent interpreter where appropriate.
Learn more about independent medical examinations in British Columbia.
When Should You Contact a Disability Lawyer About an IME?
Speak with a disability lawyer as soon as the insurer requests an IME if:
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Your benefits are already under review
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The assessment is scheduled near the two-year change of definition
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Your doctor believes the examination could harm you
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The insurer selected an assessor with an unrelated specialty
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You need accommodations that the insurer has refused
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The location or duration is unreasonable
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The insurer has requested repeated assessments
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The IME report misrepresents what happened
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Your LTD benefits were denied or cut off after the assessment
A disability lawyer can review the policy, assessment request and referral questions and identify problems before the examination takes place.
If the report has already been completed, a lawyer can help obtain the report, identify weaknesses, coordinate medical evidence and challenge a denial or termination.
Frequently Asked Questions About IMEs
Can My LTD Insurer Force Me to Attend an IME?
Most LTD policies require you to attend a reasonable medical examination requested by the insurer. Refusing can lead to suspended or denied benefits. Get legal advice before objecting.
Is an Independent Medical Assessment the Same as an IME?
Yes. Independent medical assessment, independent medical evaluation and independent medical examination are commonly used to describe the same type of insurer-requested assessment.
Does the IME Doctor Become My Doctor?
No. The examiner isn’t treating you and doesn’t establish an ordinary doctor-patient relationship. The examiner prepares an opinion for the organization that requested the assessment.
Should I Bring My Medical Records?
Only bring documents requested or approved in advance. Ask what records the insurer has already provided and whether the assessor wants anything else.
Can I Bring Notes to an IME?
You can ask whether brief notes, a medication list or a medical timeline are permitted. Don’t rely on a prepared script when answering questions.
Can I Record the Examination?
Ask for permission in writing before the appointment. Don’t secretly record the assessment. The examiner can refuse or impose conditions if recording will interfere with the process.
Can Someone Come Into the Examination With Me?
You can request a support person, observer or accommodation, but approval isn’t automatic. Make the request early and provide medical support when needed.
Can I Get a Copy of the IME Report?
Ask the insurer in writing for the complete report. Depending on the circumstances, it can be provided directly to you or through your treating doctor.
Can the Insurer Send Me to More Than One IME?
An insurer can request more than one assessment when different expertise is reasonably needed. Repeated, duplicative or irrelevant examinations can be challenged.
What if I’m Too Sick to Travel to the Examination?
Don’t simply miss the appointment. Explain the medical difficulty in writing and ask your doctor to recommend appropriate accommodations or an alternative arrangement.
What Happens if the IME Doctor Says I Can Work?
The insurer can rely on the opinion to deny or terminate benefits. The report can be challenged using factual corrections, medical evidence from your treating professionals and legal action against the insurer.
Get Help Before or After an Independent Medical Examination
An IME can have a major impact on whether your LTD benefits continue. Don’t treat it as a routine medical appointment or wait for the insurer to use the report against you.
Samfiru Tumarkin LLP represents people with long-term disability claims throughout Canada, excluding Quebec.
Our disability lawyers can review the assessment request, help you prepare, address unreasonable conditions and challenge an inaccurate IME report.
Contact us for a free consultation if you have been asked to attend an IME or your benefits were denied after one.