Why LTD Terminations Happen After an Independent Medical Exam

Receiving notice that your long-term disability (LTD) benefits are being terminated after an Independent Medical Exam (IME) is a distressing experience. While IMEs are presented as “independent” reviews, they are often strategic tools used by insurance companies to justify ending payments. Understanding why this happens is the first step in fighting back.

Here are the primary reasons LTD claims are terminated following an IME:

• Discrepancies in Medical Opinions: The IME doctor’s report conflicts with your treating physician’s assessment.
• Lack of “Objective” Evidence: The examiner claims there is insufficient proof of your functional limitations.
• Perceived Non-Compliance: The insurer argues you are not following recommended treatments or are exaggerating symptoms.
• Change in Definition of Disability: The IME is timed to coincide with a policy shift from “own occupation” to “any occupation.”

How Insurers Use IMEs to Reassess Claims

Insurance companies have a financial incentive to minimize payouts. An IME allows them to bring in a doctor, often one they hire regularly, to review your condition. Unlike your treating physician, who sees you regularly, an IME doctor may spend only 15 to 30 minutes with you. Despite this brief interaction, their report can carry significant weight.

If the IME report states you can return to work, the insurer will use this “new evidence” to supersede years of records from your own doctors. This tactic is especially common when claims involve subjective conditions like chronic pain, fatigue, or mental health disorders, where “objective” tests like X-rays are not definitive.

The Problem of Bias in Independent Exams

The term “independent” is often a misnomer. Many IME doctors earn a substantial portion of their income from insurance referrals. This financial relationship can create a subconscious (or conscious) bias to produce reports that favor the insurer.

A common issue we see is the “paper review” vs. “clinical reality.” An IME doctor might note that you could sit, stand, and walk during the brief exam, concluding you can work an eight-hour day. This ignores the reality of stamina, pain flare-ups, and the cumulative effect of work activity over a week—factors your treating physician understands far better.

Protecting Your Rights During and After an IME

If you are scheduled for an IME or have just received a termination letter, you need to act strategically:

1. Bring a Witness: If permitted, bring a friend or family member to the exam to take notes on start/end times and what tests were actually performed.
2. Request the Report: You have a right to see the IME report. Review it carefully for factual errors. Did the doctor claim to do tests they didn’t perform? Did they misquote you?
3. Rely on Your Treating Physician: Ask your doctor to review the IME report and write a rebuttal explaining why the IME’s conclusions are medically unsound based on your long-term history.

Your Success Is Our Priority

A termination notice is not the end of the road. It is a hurdle that can be overcome with the right evidence and legal guidance. At Bartolic Law, we expose the flaws in biased IME reports and help reinstate benefits for our clients.

If your claim has been terminated following an IME, do not face the insurance company alone. Contact us today for a consultation and let us help you turn that denial into an approval.