Understanding IMEs, Your Rights, and How to Protect Your Disability Claim
If you’ve received a notice that your long-term disability (LTD) insurance company is requiring you to attend an IME, or Independent Medical Examination, it’s natural to feel concerned — even afraid. These exams are not what they appear to be. In fact, we prefer to call them DMEs — Defense Medical Examinations — because they are often designed to protect the insurance company, not you.
At Newfield Law Group, we help disabled individuals prepare for and respond to these exams so their rights are protected, and their claims are not unfairly denied. Here’s what you need to know.
What is an IME (or DME)?
An IME is an exam conducted by a doctor chosen and paid for by your disability insurance company. These exams are allowed under many LTD policies. However, they are far from independent.
Often, the doctors performing these exams are part of networks owned or managed by the insurance companies themselves. In some cases, these physicians repeatedly perform evaluations that find claimants “able to work,” even when the evidence strongly suggests otherwise. Courts have repeatedly criticized insurance companies for their overreliance on biased IME reports.
Why Should You Be Worried?
There are several red flags associated with DMEs:
- Bias: Doctors paid by insurers may feel pressured to provide findings that support claim denials.
- Skewed Medical Records: Insurers may only send cherry-picked portions of your medical file to the examining physician — leaving out information that supports your claim.
- Unfair Tactics: Some insurers schedule exams without consulting you, send you far from home, or use last-minute notifications to create hardship.
- Surveillance: Insurance companies may follow or record you before and after the exam to try to discredit your claim.
They may force you to travel long distances to see a doctor, then claim you have functionality to travel.
We work hard to make sure none of these tactics compromise your case.
Is the Exam Required?
Not every LTD policy includes a requirement that you undergo a DME – although most do – but that does not end the inquiry. That’s why we carefully review every client’s policy before advising them how to proceed. If your policy doesn’t require a DME, or discussed the frequency of examinations, or if the examination (or testing) may cause harm, you may have the right to refuse the exam — and we’ll fight to protect that right.
What About Functional Capacity Evaluations (FCEs)?
You may also be asked to undergo a Functional Capacity Evaluation (FCE). This test measures your physical ability to perform tasks like lifting, standing, or walking. FCEs are risky for disabled individuals.
Why? Because they are generally designed to push your body to its limits — and beyond.
- If you try to give maximum effort, you risk injury or worsening your condition. The insurance company uses your good efforts as your floor level of function, when it is your ceiling.
- If you stop because of pain or fatigue, the examiner might claim you weren’t trying hard enough and accuse you of malingering.
This is a classic lose-lose situation, and with many years of experience, we know that FCEs must be treated with extreme caution.
How Newfield Law Group Help You Prepare
At Newfield Law Group, we take the following steps to ensure you’re not walking into a trap:
- Medical Coordination We advise scheduling an appointment with your treating physician on the same day, or within a day of the exam. Their notes could be vital in disputing any false claims made in the DME report.
- Complete Medical Records We send the examining doctor your full medical file, not just the cherry-picked versions insurers provide. This gives the examiner the full picture — and gives you a fairer evaluation.
- Bring a Witness Never go to a DME or FCE alone. A trusted family member or friend should accompany you as a witness to how you were treated and what happened during the exam.
- Record the Exam You have the right to video-record the examination. While doctors may push back, this is a legal right in many jurisdictions, and we notify the examining physician in advance that our clients may be recording.
How to Conduct Yourself During the Exam
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Be Honest: Don’t downplay your pain, but don’t exaggerate either.
- Speak Up: If something hurts, say so. If you need to stop, say you need to stop.
- Don’t Be a Hero: Trying to show that you can work through the pain could cause harm both to your body and your case.
- Ask for a Report: Before you leave, ask how and when you can get a copy of the doctor’s report.
Watch Out for Surveillance
In some cases, insurers post investigators near the exam site. We’ve seen clients caught on video simply expressing relief that the exam is over — laughing or stretching in the parking lot — and those moments were twisted and used against them.
Surveillance isn’t limited to the exam day. Insurance companies may monitor your activities regularly — through video, social media, or even drones. If you’re supposed to be unable to work due to limited mobility but you’re recorded walking your dog or lifting groceries, your claim may be challenged.
Keep Symptoms & Appointments Logs
We recommend every client maintain two logs:
- Symptom Log – A daily record of how you feel, your pain levels, and what activities you’re able (or unable) to do. This helps build a timeline of your condition.
- Appointment Log – Track all medical visits, therapy sessions, and even social activities. If you go out once a month to visit a friend and it leaves you exhausted for days, that’s relevant evidence for your case.
Newfield Law Group Can Help
You need to be prepared for a DME. These exams are not neutral and can have a significant impact on your claim. The more informed and proactive you are, the better chance you have of protecting your benefits.
At Newfield Law Group, we take a hands-on approach to DME and FCE preparation. We don’t let insurers dictate the narrative — we make sure the truth about your condition is front and center.
Have you been asked to attend a DME or FCE? Don’t go it alone. Contact us immediately so we can help you protect your rights and your future.
