An Insurance Medical Examination (IME) is intended to assess your medical condition and how it influences your working capacity, but the doctor performing the exam is selected and paid by the insurer. Many people pursuing private disability benefits are surprised when the insurance company schedules a medical exam with a doctor they have never met. The request can feel intimidating, especially if you already have a treating physician who understands your condition.
An IME is a medical evaluation requested by an insurance company, typically during a private disability claim review, to assess whether your condition supports continued or approved benefits.
Why Insurance Companies Request Medical Examinations
Insurance companies often request an IME when they want another opinion about a claimant’s medical condition. Even when you have detailed records from your own doctor, the insurer may still seek an additional evaluation before approving or continuing disability benefits. There are several factors that commonly lead to these requests, including:
- Verification of medical information: The insurer may want confirmation that the diagnosis and symptoms documented in your records match your current condition.
- Assessment of work limitations: The doctor conducting the exam may be asked to evaluate how your condition affects your ability to undertake job duties.
- Review of long-term claims: In long-term disability claims, insurers sometimes request updated exams to determine whether a condition has improved, remained stable, or worsened.
- Evaluation of conflicting records: If medical notes or reports differ, the insurer may order an exam to gather another perspective.
- Alternative explanations: The doctor evaluates whether your condition is disabling or if your symptoms result from another cause.
- Opportunity for surveillance: some insurance companies will schedule your IME and use it as a chance to spy on you before and after the examination.
An IME usually involves:
- A review of your medical history
- A physical or cognitive evaluation related to your condition
- Documentation of symptoms, daily activities and job responsibilities
The IME doctor’s report becomes a central piece of evidence in your file. It is important to remember that this doctor does not replace your treating physician. Your own doctor remains the professional who understands your full medical history, treatment plan, and ongoing care. The insurance company’s exam is simply one piece of information used during its review of a private disability claim.
Because the insurer arranges the exam, the results may influence whether benefits continue, are modified, or are denied. It is important to prepare for the exam so that the appointment goes smoothly. Many claimants find it helpful to keep a clear record of their symptoms and treatment leading up to the exam. When you know what the exam is designed to assess, you can go into the appointment prepared and ready to protect your interests.
Contact Our Disability Claim Team
If an insurance company has scheduled an IME as part of your private disability claim, you have rights during this process. Our team at Raval Trial Law can explain your rights and guide you through every step of the private disability claims process.
At Raval Trial Law, we help people facing private disability insurance disputes and make sure you can speak directly with an attorney instead of waiting on a chain of assistants when you need answers. Call (713) 324-8118 to speak with our team and discuss your options.
