Table of Contents[Hide][Show]
- What Does It Mean If an Insurer Never Requests an IME?
- Why Would an Insurer Choose a Paper Review Over an IME?
- Doesn’t ERISA Require an Actual Examination?
- Is a Paper Review Better or Worse for a Claimant Than an IME?
- What Should You Do If Your Insurer Relies on a Paper Review Instead?
- Is It Worth Getting an Attorney Involved Over a Paper Review?
- Frequently Asked Questions
- Sources
Many claimants expect that at some point during a long-term disability (LTD) claim, the insurer will schedule an independent medical examination (IME). When that call never comes, it’s tempting to read it as a good sign, but that is not always the case. Here’s what’s actually happening when an insurer skips the IME.
What Does It Mean If an Insurer Never Requests an IME?
An IME is only one of several tools an insurer can use to evaluate a claim, not a required step in every case. Many insurers instead rely on a paper review, also called a peer review, in which a physician hired by the insurer evaluates the existing medical records without ever examining the claimant in person. Skipping the IME doesn’t mean the insurer has decided the claim is solid; it more often means the insurer believes it can reach the conclusion it wants without the added time and cost of a physical exam.
Why Would an Insurer Choose a Paper Review Over an IME?
Cost and control are the two biggest factors. An IME requires scheduling, travel, an examiner’s fee for an actual appointment, and a claimant who is physically present and able to describe symptoms directly to a doctor, all of which take time and money an insurer may not want to spend on a claim it has already decided is weak. A paper review is faster and cheaper, and because the insurer selects both the reviewing physician and the specific records sent for review, it offers more control over what the reviewer sees and, often, what the reviewer concludes.
Doesn’t ERISA Require an Actual Examination?
No. Federal regulations governing ERISA disability claims require that a plan consult with a qualified health care professional when a denial is based on medical judgment, but that requirement doesn’t specify a physical examination. A paper review by a licensed physician satisfies the consultation requirement just as well, on paper, as an in-person exam does. That gap is exactly why file reviews have become such a common substitute for IMEs in LTD claims administration.
Is a Paper Review Better or Worse for a Claimant Than an IME?
Neither format guarantees a fair outcome, and each carries its own risk. An IME at least puts a claimant in front of a licensed physician who observes symptoms directly, even if that physician was chosen and paid by the insurer. A paper review removes that observation entirely. The reviewing physician never sees how a claimant moves, sits, or struggles with a task. They’re limited to whatever is written in the file, which makes the quality and detail of the existing medical records more important than ever.
What Should You Do If Your Insurer Relies on a Paper Review Instead?
Treat the absence of an IME as a reason to strengthen the written record, not a reason to relax. Ask the insurer, in writing, for the reviewing physician’s name, credentials, and specialty, since a general practitioner reviewing a complex neurological or psychiatric claim is a legitimate point to challenge. Request a copy of the paper review report once it’s issued, and compare its conclusions against the actual treatment notes it claims to summarize; paper reviews sometimes mischaracterize or selectively cite the record. Ask the treating physician for a detailed, function-specific response to any conclusions the paper review reaches.
Is It Worth Getting an Attorney Involved Over a Paper Review?
A paper review denial is harder to challenge alone than it looks, because the reviewing physician’s opinion is built entirely from documents rather than a live encounter a claimant could push back on directly. Once that kind of review has actually produced a denial or termination, involving an attorney is strongly advisable. Building an effective response means knowing what these reviews typically get wrong, from cherry-picked chart notes to conclusions that go beyond what the reviewer was actually qualified to assess, and structuring the appeal around those specific weaknesses rather than simply resubmitting the same file.
If your long-term disability claim was denied, whether it was based on a paper review or an in-person exam, Ortiz Law Firm can help you challenge it. Call (888) 321-8131 for a free case evaluation.
Frequently Asked Questions
If my insurer never sent me for an IME, does that mean my claim is in good shape?
Not necessarily. Skipping an IME often means the insurer plans to rely on a paper review by a physician who never examines the claimant in person, rather than a sign the insurer is satisfied with the claim. It’s worth treating the written medical record as more important than ever, since that’s likely the entire basis for the insurer’s next decision.
Can an insurance company deny my claim without ever having a doctor examine me?
Yes. ERISA regulations require a plan to consult a qualified health care professional when a denial involves medical judgment, but that requirement doesn’t specify an in-person exam. A paper review by a licensed physician who only reviewed the file satisfies that requirement, which is part of why file reviews have become so common in LTD claims.
What should I ask for if I find out my claim was decided by a paper review?
Request the reviewing physician’s name, credentials, and specialty in writing, along with a copy of the review itself. Compare its conclusions against your actual treatment notes, since paper reviews sometimes mischaracterize or selectively cite the medical record, and ask your treating physician to respond directly to any conclusions you believe are inaccurate.
Sources
- U.S. Department of Labor, Employee Benefits Security Administration. “Compliance Assistance – Group Health and Disability Plans Benefit Claims Procedure Regulation (29 CFR 2560.503-1)” Retrieved from: (https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/publications/group-health-and-disability-plans-benefit-claims-procedure-regulation) Accessed on August 6, 2026
- Electronic Code of Federal Regulations (National Archives / U.S. Government Publishing Office). “29 CFR § 2560.503-1 – Claims procedure” Retrieved from: (https://www.ecfr.gov/current/title-29/subtitle-B/chapter-XXV/subchapter-G/part-2560/section-2560.503-1) Accessed on August 6, 2026
