The independent medical examination (IME), explained
The regulation's neutral-reviewer rule is not the same thing as your plan's own IME clause. Here is the difference.
ERISA's claims-procedure regulation requires that an appeal reviewer be "neither the individual who made the adverse benefit determination that is the subject of the appeal, nor the subordinate of such individual," and where the denial rests on a medical judgment, requires the plan to consult a health care professional who was not involved in the original denial. That is a genuine, regulation-mandated neutral-reviewer requirement.
What the regulation does NOT do is require, or even describe, sending you to an outside "independent medical examination" (IME) with a doctor the insurer selects. That is a separate, plan-specific arrangement: many LTD plan documents reserve a contractual right to require you to attend an IME, or to submit to a records-only review by a paid consultant, as a condition of continuing benefits. Whether your plan has that clause, what happens if you decline, and how much weight the examiner's opinion carries are all questions answered by your specific plan document, not by this federal regulation.
If you are asked to attend an IME
Check your plan document (or your summary plan description) for the specific IME clause and what it requires. Attend on time, bring a factual, complete account of your symptoms and limitations, and consider requesting a copy of the examiner's report for your file once it exists, since it will likely become part of your claim record either way.
Sources
29 CFR 2560.503-1(h)(3)(ii)-(v). Checked 2026-09-16.