The IME Doctor Does Not Work for You. Know That Going In
What an IME Is and Why It Matters in an ERISA Claim
An insurance medical examination — called an IME or sometimes a defense medical examination — is a physical examination or medical records review ordered by the disability insurer at its expense. The examining physician typically spends 20 to 45 minutes with you, then produces a written report. That report often forms the evidentiary backbone of a denial or termination. In ERISA litigation, the IME report becomes part of the administrative record that a federal judge reviews. Countering it effectively requires preparation before the exam and independent medical evidence in the record.
What you need to know
Plain-English answers to the questions that come up most often on these cases.
File-Review vs. In-Person IME
Some insurers skip the in-person examination entirely and have a physician review your medical records without ever meeting you. Courts have noted skepticism toward paper-only reviews that reject treating physicians who actually examined the claimant, though ERISA does not require insurers to give treating physicians special deference.
Read moreThe Examination Is Brief — and That Is Intentional
A 30-minute examination cannot replicate years of treating physician observation. Document your worst days, your functional limitations, and your symptom variability in writing before the exam. Bring a written summary. Do not minimize or perform for the doctor.
Read moreYour Right to Record the Exam
New York law permits recording of independent medical examinations in certain circumstances. Discuss this with your attorney before the exam — a recording protects you against a report that mischaracterizes what was said or observed.
Read moreWhat the Insurer Will Do with the Report
If the IME supports the insurer, expect a denial or termination letter within 45 days. The report will be cited as objective evidence overriding your treating physicians. Having an independent medical opinion in the record before the IME report arrives gives you something to fight back with.
Read moreCounter with Your Own Independent Evaluation
The most effective response to an adverse IME is your own independent medical examination or a detailed written rebuttal from your treating specialist. Ensure your treating physician specifically addresses — and disagrees with — each conclusion in the insurer’s report.
Read moreConsistency Between the IME and Your Daily Reality
Insurers compare IME findings against surveillance footage, social media activity, and activity logs. If you tell the IME doctor you cannot stand for more than ten minutes, that statement will be cross-referenced against every photograph and video taken of you. Be truthful and precise — not strategic — about your actual limitations.
Read moreHow we handle these cases
Step 1
Brief clients thoroughly on what to expect, what to say, and what not to minimize before any IME.
Step 2
Review the examining physician’s publication and testimony history for bias patterns.
Step 3
Obtain an independent medical evaluation to place in the administrative record as a counter-opinion.
Step 4
Draft a detailed rebuttal to adverse IME reports for submission during the appeal.
Step 5
Preserve all communications with the insurer regarding the IME scheduling and scope.
Real cases. Real results.
Three recent Long-Term Disability outcomes — case context and result. No client identifying information.
An insurer cited a file-review physician’s opinion that a claimant with fibromyalgia could return to sedentary work. We submitted an in-person independent examination from a rheumatologist whose opinion directly addressed the file reviewer’s methodology. The appeal succeeded and benefits were reinstated.
We identified that the examining physician had testified for the insurer in over 80 percent of his reported cases that year. We cited this pattern in the appeal brief and argued it was evidence of the structural conflict under Glenn. The insurer reversed the denial.
After an ERISA denial based solely on an IME, we litigated in federal court. The district court found the insurer’s reliance on a paper review — without any in-person examination — over four years of treating physician documentation to be an abuse of discretion.
Prior results do not guarantee a similar outcome. Each case is evaluated on its own facts. The case outcomes shown are representative examples; details have been altered or generalized to protect client confidentiality.
Related questions
Quick answers from our FAQ library.
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Brian M. Mittman, Esq.
Managing Partner · Markhoff & Mittman, P.C.
Call 866-205-2415 Schedule with Brian- Admitted in New York
- 30+ years in practice
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Brian has personally handled New York workers' compensation, SSDI, and personal-injury cases for over three decades. Your case is never handed off to a paralegal.
- Admitted in New York and New Jersey
- Pace University School of Law, J.D.
- Litigates before the Workers' Compensation Board
Randy has litigated every type of claim before the Workers' Compensation Board on behalf of hundreds of claimants.
- Admitted in New York, 2008
- New York Law School, J.D. 2007
- With The Disability Guys since 2013
Benai has spent more than a decade fighting for injured workers before the Workers' Compensation Board and the New York State Employees' Retirement Board.
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