Your LTD Insurer Wants You to See Their Doctor. Should You Go?

A letter arrives in the mail. The insurance company that has been paying your long-term disability benefits, or the one that has just told you your file is under review, is sending you to a doctor. The appointment is in two weeks. The address is somewhere across the city, possibly across the province. You have never met this doctor. You will probably never see them again. And the report they write will go straight back to the insurer.

If your stomach dropped when you read the letter, you are not overreacting. An independent medical examination is a real moment in a long-term disability file, and how it goes can affect whether your benefits continue. The good news is that in almost every case the right answer is to attend. The harder truth is that how you prepare and conduct yourself matters enormously, and the right approach depends on your specific situation.

What follows is a plain-English walkthrough of what an IME actually is, why insurers schedule them, what to do before and on the day, and what your options are if the report comes back against you. This article is general information about Ontario long-term disability claims, not legal advice for your file. Anyone facing an IME should speak with a lawyer about their specific circumstances before deciding how to proceed.

What an Independent Medical Examination Actually Is

An independent medical examination, usually shortened to IME, is an appointment with a doctor you do not know, arranged by your insurance company, for the purpose of producing a written medical opinion about your condition. The doctor reviews records the insurer sends them in advance, conducts an examination of some kind, asks you questions, and then writes a report. That report goes to the insurance company, not to you, and not to your treating physicians.

The word "independent" is the part that confuses most people. It is also the part that matters most. The doctor performing the IME is selected by the insurance company and paid by the insurance company. They are not your doctor. They are not a neutral third party appointed by a court. They are a paid expert retained by one side in what is, at this stage, a quiet dispute about whether you are still entitled to benefits.

Insurers schedule IMEs for a few different reasons. Sometimes the goal is to obtain a medical opinion that will support terminating or denying benefits. Sometimes it is to satisfy a clause in the policy that allows the insurer to require periodic re-examinations. Sometimes it is to challenge the opinions of your treating physicians by getting a competing opinion from a doctor who has never treated you.

Most long-term disability policies in Ontario contain a clause requiring the claimant to cooperate with reasonable medical examinations. Refusing to attend an IME, without a good reason that is properly communicated to the insurer, typically gives the insurer grounds to suspend or terminate benefits. That is why outright refusal is almost never the right move.

So Should You Go?

In almost every case, yes. The reason is straightforward. Refusing typically triggers a benefits cutoff and shifts the legal posture against you. If your file ever ends up in court, a judge looking at a refusal to attend a reasonable medical examination is rarely sympathetic to the claimant.

That said, every situation is unique. There are cases where the right move is to push back, in writing and through a lawyer, on the timing of the appointment, the location, the scope of the exam, or the specific examiner the insurer has chosen. That is a conversation to have before the appointment, not after. This article describes general principles. It is not a substitute for advice tailored to your file.

Before the Appointment

Preparation is the single most useful thing you can do once the letter arrives. The decisions you make in the days before the IME often shape the report more than the appointment itself does.

• Confirm the appointment in writing. Reply to the insurer (or whoever scheduled the appointment) confirming the date, time, location, and the name of the examining physician. Keep a copy of every piece of correspondence, including the original letter, and save any emails. If the appointment changes, ask for the change in writing.
• Ask, in writing, who the examining physician is and what their specialty is. Ask what records have been sent to the examiner in advance. The insurer is not always required to give you everything, but the request itself is useful, and the answers (or refusals) become part of the record.
• Speak to a lawyer before you go, if you have not already. A short consultation can flag issues with the chosen examiner, the scope of the exam, the timing, or the location. It is far easier to address those issues before the appointment than to clean them up afterward.
• Review your own medical history. Skim the notes from your treating physicians, the medications you are on, the dates of significant appointments, and how your symptoms have changed over time. Your account at the IME should be consistent with what your treating doctors have already documented. Inconsistencies are one of the main things insurers use to deny claims, and most of them are accidents of memory rather than dishonesty.
• Plan logistics carefully. Think about travel time, parking, fatigue, and pain medication timing. Insurers sometimes schedule IMEs far from the claimant's home, and arriving exhausted can affect both how you present and how you feel. If the location is unreasonable, that is a reason to push back through a lawyer, not a reason to skip the appointment.

On the Day of the Examination

By the morning of the IME, the heavy lifting should already be done. The job on the day itself is to show up, be honest, be observant, and not give the insurer anything to use against you.

• Be on time. Arriving late or missing the appointment can be characterized as non-cooperation. Plan to be at the building at least fifteen minutes early.
• Bring a support person if possible. They cannot usually sit in the examination room itself, but they can be in the waiting room. They can help you remember what was asked and how long the appointment lasted. They can also drive you home if you are exhausted afterward.
• Be honest. Do not exaggerate. Do not minimize. Describe your bad days and your good days truthfully. Many claimants instinctively downplay their symptoms because that is what they do every day with family and coworkers. Others, worried about being dismissed, push their symptoms in the other direction. Both habits hurt the claim. Accurate is better than dramatic.
• Answer the questions asked. Do not volunteer additional information, do not speculate, and do not guess at dates if you are not sure. "I do not remember" is a perfectly acceptable answer. So is "I would have to check my records." The examiner is taking notes, and tentative guesses can later be quoted as confident statements.
• Take your own notes immediately after the appointment. How long did it last? What tests were performed? What questions were asked? How did you feel during and after? Memory fades quickly, and these notes can matter later if there is a dispute about what happened in the room.
• Assume you may be observed before and after the appointment. Surveillance is common in disability files. How you walk to your car, how you carry a bag, whether you stop for coffee, whether you bend to pick something up: all of it can end up in a report. This is not a reason to perform. It is a reason to behave the same way you would on any other day, including using the supports and accommodations you actually use.

Red Flags to Watch For

Most IMEs are uncomfortable but professional. Some are not. Knowing what an irregular exam looks like helps you describe it accurately afterward, which matters if the report ever has to be challenged.

• An examiner who does not perform a physical examination but writes a detailed report on physical findings.
• An exam that lasts only a few minutes followed by a lengthy report covering far more ground than the appointment did.
• Questions that go far beyond the medical condition at issue, such as detailed inquiries about household finances or personal relationships unrelated to the disability.
• A report that misquotes you or omits important parts of the medical history that you discussed in the room.
• Pressure from the insurer to attend on extremely short notice, or to travel an unreasonable distance, without a good explanation for the urgency.

If any of these come up, document them carefully and tell your lawyer.

After the Examination

The appointment ends, you go home, and then you wait. The IME report typically arrives at the insurer first. From there, a few things can happen.

• Request a copy of the IME report. Under Ontario privacy and health information law, claimants generally have the right to receive a copy of any medical report prepared about them. Ask the insurer for it in writing. Keep a record of the request and the response.
• Read the report carefully when it arrives. Compare it to what you actually said and what was actually done at the exam. Note any inaccuracies, missing context, or facts the report appears to overlook. Your own post-appointment notes are useful here.
• Do not assume an unfavourable report ends the claim. An IME report is one piece of evidence. The opinions of your treating physicians, functional capacity evaluations, your own day-to-day evidence of limitations, and the policy language itself all still matter, often more than the IME does.
• If your benefits are terminated or denied based on the IME, do not accept the decision as final. Contact a lawyer. There are strict limitation periods in Ontario for challenging a long-term disability denial, and acting quickly preserves all of your options. Under the Limitations Act, 2002, a claim to recover denied disability benefits must generally be started within two years. Internal appeals do not stop that clock.

When to Push Back

Sometimes the right answer is not "go and hope for the best." Sometimes it is to attend, but only after raising specific concerns in writing. Examples include situations where the proposed examiner has a documented history of bias, the specialty does not match the condition at issue (a general practitioner asked to opine on a complex psychiatric condition, for instance), the location is unreasonable, or the timing conflicts with active treatment that should not be interrupted.

Pushing back is a legal strategy decision. It should be done through a lawyer, in writing, with clear reasons. It is not the same as not showing up. A claimant who simply does not appear, without explanation, looks uncooperative. A claimant whose lawyer has written to the insurer raising specific, documented concerns, and proposing alternatives, looks like someone trying to participate in a fair process. The difference is enormous when the file ends up in front of a judge.

The Bottom Line

Yes, in most cases you should attend the IME. The doctor is not your enemy, but they are not your advocate either, and the appointment is part of a process the insurer has scheduled for its own reasons. How you prepare, how you conduct yourself, and what you do afterward can shape the outcome of the entire claim. Every situation is different, and a short conversation with a lawyer before the appointment is worth far more than trying to undo a damaging IME report after the fact.

Learn more about how I handle long-term disability claims in Ontario.

Not sure if you have a claim? Take the 60-second assessment to get started. It's free and confidential.

Claim.ca is a free platform operated by Marty Mikhail, a lawyer licensed by the Law Society of Ontario. Legal services are provided by Lemonade Law^™, Marty Mikhail's personal legal practice.