If you’ve made a Total and Permanent Disability (TPD) or income protection claim, there’s a good chance your insurer will ask you to attend an Independent Medical Examination (IME).
It can be a scary thought.
You’ve already provided your doctors’ reports in great detail. Why do they want another opinion? And what will really happen when you go to an IME?
This guide covers:
- What an IME is, and why insurers use them.
- What to expect before, during and after the exam.
- The common traps.
- Tips to help you prepare and protect your claim.
- What you can do if you disagree with the report.
What is an Independent Medical Examination (IME)?
An IME is an assessment by a doctor or specialist appointed (and paid for) by the insurer, or sometimes by the super fund trustee.
The aim is to get an “independent” opinion on your medical condition, your functional capacity, and your ability to work.
However, the word “independent” can be misleading:
- The IME doctor is not your treating doctor.
- Their job is to prepare a report for the insurer, not to treat you or advocate for you.
- Insurers often rely heavily on IME reports when making decisions.
Why Do Insurers Request an IME?
Insurers order IMEs to:
- Confirm your diagnosis and the severity of your condition.
- Assess whether your disability is permanent.
- Determine whether you could do some form of work (not necessarily your old job).
- Check you’ve followed appropriate treatments.
- Spot any inconsistencies between your treating doctors’ reports and your presentation.
In short: insurers like IMEs because they provide another opinion they can use to assess — and sometimes dispute — your claim.
Types of IMEs
Depending on your condition, you may be referred to:
- General practitioners (GPs): broad assessment.
- Psychiatrists or psychologists: for depression, anxiety, PTSD, or other psychiatric claims.
- Orthopaedic surgeons: for musculoskeletal injuries (e.g. back, knees, shoulders).
- Neurologists: for brain and nerve conditions.
- Occupational physicians: to review your functional capacity for work.
Sometimes insurers order multiple IMEs across specialties to build a more comprehensive picture — or to find contradictions.
What Happens Before the IME?
- Appointment notice: You’ll be notified of the time, date, and specialist. Insurers usually pay.
- File review: The IME doctor will be given your medical records, claim forms, and sometimes even surveillance footage.
- Pre-exam questionnaires: You may be asked to complete forms about symptoms, daily activities, and work history.
Tip: Always confirm the appointment and keep a record of correspondence. If the date or location is unreasonable, you can request an alternative.
What Happens During the IME?
1. Interview
The doctor will ask about:
- Medical history.
- How your condition affects daily life.
- Treatments tried.
- Work and education history.
They may cross-check your answers with records for consistency.
2. Examination
- Physical conditions: tests of strength, mobility, reflexes, balance, lifting capacity.
- Psychological conditions: structured interview, questionnaires, assessment of mood, memory, concentration, and behaviour.
3. Observation
IME doctors often note how you behave before, during, and after the exam. For example:
- Did you struggle to get out of your chair?
- Did you walk differently leaving the clinic?
- Did you drive yourself?
4. Duration
Most IMEs last 30–90 minutes, depending on complexity.
What Happens After the IME?
- IME report prepared: The doctor writes a report for the insurer (not for you).
- Report sent to insurer: You may not automatically get a copy — but you can request one.
- Claim decision influenced: Insurers often give the IME more weight than treating doctors’ reports.
How Insurers Use (and Misuse) IME Reports
While IMEs can provide helpful independent evidence, insurers sometimes misuse them:
- Giving the IME more weight than years of treating doctor evidence.
- Highlighting inconsistencies while ignoring supportive parts of the report.
- Ordering repeat IMEs until they get the “opinion” they want.
- Using vague IME conclusions to justify denial (“patient could do some form of work”).
This is why it’s critical to be prepared and to challenge errors if they occur.
Common Traps with IMEs
- Thinking the doctor is there to help you – They’re assessing, not treating.
- Inconsistent answers – If your answers differ from records, it damages credibility.
- Downplaying symptoms – Pride leads some to minimise their condition; insurers use this to argue recovery.
- Exaggerating symptoms – Overstatement backfires when unsupported by records.
- Body language observations – IME doctors note how you walk, sit, or interact, even outside the exam room.
- Not checking the report – IME reports often contain mistakes or unfair interpretations.
Tips to Prepare for an IME
- Be honest and consistent – Don’t minimise or exaggerate.
- Bring a support person – A family member may be allowed as a witness.
- Take your job description – Helps link your disability to your duties.
- Review your medical history – Know your treatment timeline.
- Request a copy of the report – Correct errors early.
- Seek advice before attending – Lawyers can explain what to expect and how to respond.
Real-Life Examples
Case 1: Back Injury (Physical Condition)
Mark, a 46-year-old mechanic, had a chronic back injury. His GP and surgeon agreed he couldn’t return to physical work. The insurer sent him to an IME with an occupational physician, who reported he could do “light desk work.” With legal support and vocational evidence, Mark’s claim was eventually approved.
Case 2: PTSD (Mental Health Condition)
Samantha, a nurse, developed PTSD. Her IME psychiatrist suggested she could return to a “low-stress” admin role. With additional psychiatric evidence from her treating doctors showing she couldn’t tolerate any workplace environment, the IME was successfully challenged and her claim approved.
Case 3: Neurological Disorder
David, diagnosed with multiple sclerosis, attended a neurologist IME. The report highlighted inconsistencies in walking ability. His lawyer obtained further functional assessments that confirmed his limitations. The insurer eventually accepted the claim.
Lesson: IME reports are powerful but not always final. Strong counter-evidence can prevail.
How to Challenge an IME Report
If you disagree with an IME:
- Request a copy of the report – You are entitled to see it.
- Check for errors – Inaccurate details, missing context, or contradictions.
- Get clarifications from treating doctors – Ask them to respond to the IME’s findings.
- Submit additional evidence – Functional capacity evaluations, updated specialist reports.
- Escalate if necessary – Through internal review, AFCA, or legal proceedings.
FAQs
Do I have to attend an IME?
Usually yes. Refusing may give insurers grounds to reject your claim.
Do I get to choose my IME doctor?
No. The insurer chooses, but you can request a different time/location.
Can an insurer request multiple IMEs?
Yes, and there’s no strict limit — but repeated requests can be challenged as unreasonable.
Will I automatically get a copy of the IME report?
Not always. You must request it.
What if I disagree with the IME report?
You can provide counter-evidence, request corrections, or escalate through AFCA/court.
Can the insurer record the exam?
Some do. You can request a copy. You may also ask to record (with permission).
Are IME doctors biased?
They are meant to be impartial, but as they’re paid by insurers, their reports often lean conservative. This is why strong treating doctor evidence is essential.
An Independent Medical Examination (IME) can be one of the most stressful stages of a TPD or income protection claim. While they’re labelled “independent,” in practice these doctors are paid and chosen by insurers, and their reports often carry significant weight.
The key is preparation: be honest, consistent, and organised. Know that the IME doctor is assessing you, not treating you. Don’t minimise or exaggerate. Bring supporting evidence where possible, and always request a copy of the report.
If the IME is unfavourable, remember: it’s not the end of the road. With strong medical evidence from your own doctors — and legal support — many IME-based denials can be successfully overturned.
At TPD Claims Lawyers, we help Australians prepare for IMEs, challenge inaccurate reports, and fight unfair denials. If you’ve been called to an IME, or if your claim has been delayed because of one, contact us today for a no-obligation chat.
Last updated: 29 August 2025