A letter arrives telling you to see a doctor. Not your doctor, and not one you asked for. This physician has never treated you, will not treat you, and was picked by the same insurance company that is deciding how much your injury is worth. If you were hurt badly enough to be reading this, that letter can feel like the moment the process turned against you.
We are MG Law, an Ontario personal injury firm that works on serious injury claims. This article explains the examination behind that letter, which is not one thing but two. The label “independent medical examination,” or IME, gets attached to two different exams that run under different law, with different rules on notice, cost, and disclosure. We will walk through both, explain why these reports deserve a careful read, and show you how to walk in prepared. It is the companion to our article on surveillance and social media, the other tool the other side uses to test your claim.
Key Takeaways
- An independent medical examination in Ontario is really two exams: a section 44 insurer’s examination in an accident benefits claim, and a Rule 33 defence medical in a lawsuit.
- A section 44 examiner is chosen and paid by your insurer, and notice must reach you at least five business days before an in-person exam.
- A Rule 33 defence medical cannot simply be demanded; it proceeds by consent or by court order under section 105 of the Courts of Justice Act.
- The insurer pays for a section 44 exam, capped at $2,000 plus HST per assessment. For many common benefits, it must send you the report within 10 business days of receiving it from the examiner.
- Tell your lawyer the day the notice arrives, bring the appointment notice, ID, and medication information, and keep seeing your own treating practitioners, because their evidence carries real weight against a single visit.
Two exams, one confusing label
After a serious crash in Ontario, you can be in two legal processes at the same time, and most people do not realise they are separate.
The first is your accident benefits claim. These are the no-fault benefits you claim from an auto insurer, regardless of who caused the crash, under the Statutory Accident Benefits Schedule, O. Reg. 34/10 (Government of Ontario). The examination your insurer can require here comes from section 44 of that regulation.
The second is your tort claim, the lawsuit against the driver who caused the crash. That driver is defended by their liability insurer, and the examination the defence can obtain here comes from Rule 33 of the Rules of Civil Procedure, R.R.O. 1990, Reg. 194 (Government of Ontario), working together with section 105 of the Courts of Justice Act (Government of Ontario).
Both get called “IMEs.” Rule 33 is officially headed “Medical Examination of Parties,” but a Rule 33 examination is commonly called an independent medical examination, and when the defence requests it, a defence medical. So when someone says they have an IME coming up, the first real question is always which one. The two run on different tracks, and confusing them is how people miss a deadline or walk in unprepared.
The section 44 insurer’s examination (accident benefits)
This is the exam most injured people meet first, because the accident benefits claim usually opens well before any lawsuit.
Its purpose is narrow. Section 44 of O. Reg. 34/10 lets an insurer require you to be examined to help it decide whether you are, or continue to be, entitled to a benefit you have applied for, but “not more often than is reasonably necessary.” The examiner is chosen and paid by the insurer and is a regulated health professional or someone with expertise in vocational rehabilitation. This person is not there to treat you. There is no treating relationship, and the appointment exists to assess your entitlement, not your health.
There is no fixed number of these exams an insurer is allowed. The limit is the “reasonably necessary” standard, which exists so the insurer can fairly assess and respond to the reports from your own side, not so it can wear you down.
What the insurer must tell you first
Before an in-person section 44 exam, the insurer has to give you real notice, and the notice has to say specific things. Under section 44(5), O. Reg. 34/10, it must set out the medical and any other reasons for the examination, whether your attendance is required, the name of the person conducting it along with their health profession and any specialty, and the date, time, and location. For an in-person exam, that notice has to arrive at least five business days ahead.
Treat the notice as your first checkpoint. Read it closely. Does it actually give reasons, or just assert that an exam is needed? Does it name the examiner and their field? Is the location somewhere you can reasonably get to? A notice that skips these requirements is not a technicality you should shrug off, because the adequacy of the notice can matter a great deal later if there is a dispute.
| What the s.44 notice must contain | What to check when it arrives |
| The medical and any other reasons for the exam | Real reasons, not just an assertion that an exam is needed |
| Whether your attendance is required | Whether you must attend in person or it is a file review |
| The examiner’s name, health profession, and any specialty | That the examiner’s field fits your injury |
| The date, time, and location | That the location is somewhere you can reasonably reach |
| Timing | At least 5 business days before an in-person exam |
Who pays, and what it can cost
You do not pay for a section 44 exam. The insurer arranges the examination at its expense, including the examiner’s fees and the cost of the report (s.44(5), O. Reg. 34/10).
There is also a ceiling on what any single assessment can cost. For accidents on or after June 3, 2019, an insurer cannot pay more than $2,000 in total, plus applicable HST, for any one assessment or examination, inclusive of all fees and expenses, per the Cost of Assessments and Examinations Guideline (FSRA). Under the schedule, “assessment” and “examination” mean the same thing: a clinical evaluation of your health status. In some cases the exam is limited to a file review, where the examiner reviews your records without you attending at all.
The report, the decision, and the deadline
After a section 44 exam that the insurer relies on to decide a benefit, you are entitled to a copy of the report along with the insurer’s decision. The exact deadline depends on the benefit being assessed, since the timing rules sit in the provisions for each benefit rather than in section 44 itself. In many common situations, including treatment and assessment plans, continuing specified benefits, and catastrophic impairment, the SABS requires the insurer to give you the report within 10 business days after it receives the report from the examiner. That is not the same as 10 days from your appointment, because the examiner may take time to write the report first.
When it arrives, read it with your lawyer, and read it for accuracy first. Reports sometimes record a history that is wrong, describe tests that were not actually done, or summarise something you said in a way you would not recognise. Those are the errors worth catching early, and the place to answer them is through your own treating practitioners.
What happens if you do not go
Skipping a properly scheduled section 44 exam has a real consequence. If the insurer has given you notice, in accordance with the regulation, that it requires the exam and you do not comply, you can be barred from taking a denied benefit to the Licence Appeal Tribunal (s.55, O. Reg. 34/10). The one protection built into that rule is that the insurer has to prove first that its notice actually met the requirements. That is exactly why the notice checkpoint above matters.
There is an important distinction here. Attending the exam protects your right to dispute a denial. It does not mean you accept whatever the report says. Those are two separate things, and you can do the first without conceding the second.
The Rule 33 defence medical (your lawsuit)
Once you are in a lawsuit against the at-fault driver, the exam changes character. By suing for an injury, you put your physical or mental condition directly in issue, and the defence is entitled to test it. The mechanism is different from section 44, and so is the level of control.
How a defence medical is ordered
A defence medical is not something the other side can simply schedule and command. It happens by agreement between the parties or, if there is no agreement, by a court order on a motion. Section 105 of the Courts of Justice Act is the source of the power: where the physical or mental condition of a party to a proceeding is in question, the court, on motion, may order that party to undergo a physical or mental examination by one or more health practitioners.
The court also guards against overreach. There is a narrower rule for the situation where one party first raises the question of another party’s condition: section 105(3) says an order in that case will not be made unless the allegation is relevant to a material issue and there is good reason to believe there is substance to it. In an ordinary injury lawsuit you have already put your own condition in issue by claiming damages for it, so the more common question is not whether an exam can happen at all but its scope and terms. Either way, courts treat these examinations as a serious intrusion on privacy, which is why they stay under judicial control rather than being handed to the defence to arrange at will.
Who conducts it and what gets disclosed
The examination is ordinarily conducted by a health practitioner as defined in section 105 of the Courts of Justice Act, which includes physicians, dentists, and qualifying psychologists. After an in-person defence medical, Rule 33.06 of the Rules of Civil Procedure requires the examiner’s report to be served on the parties. In plain terms, you get to see what the defence examiner concluded. The defence does not get to quietly commission an in-person examination and bury an unhelpful result.
Section 44 vs Rule 33 at a glance
Here is the whole distinction in one view, followed by a diagram of the two tracks.
| Feature | Section 44 insurer’s exam (accident benefits) | Rule 33 defence medical (lawsuit) |
| Which claim | No-fault benefits from your auto insurer | Lawsuit against the at-fault driver |
| Who orders it | The insurer, by written notice | The defence, by consent or court order |
| Standard | “Reasonably necessary” (s.44) | Condition “in question”; relevance and substance (s.105) |
| Notice | Contents set by s.44(5); min. 5 business days for in-person | Set by agreement or court order |
| Who chooses the examiner | The insurer | The defence, subject to the court |
| Who pays | The insurer; capped at $2,000 + HST per assessment | The defence |
| Report to you | Often within 10 business days of the insurer receiving it (varies by benefit) | In-person examiner’s report served on the parties (Rule 33.06) |
| If you do not attend | May bar a Licence Appeal Tribunal dispute (s.55) | The court can order attendance |
Why you should read an insurer or defence medical report critically
These reports are commissioned by the other side, and that is a reason to read them carefully rather than a verdict on any individual doctor. A few structural features are worth keeping in mind.
Start with who retains and pays. In both streams, the examiner is selected and paid by the party trying to limit or defend the claim: your insurer under section 44, the defendant’s insurer under Rule 33. The examiner has no treating relationship with you and no role in your recovery.
Then there is the purpose. The exam exists to assess entitlement or to produce evidence for a lawsuit, not to help you get better. A single appointment, often months or years after the crash and lasting a fraction of the time your own doctors have spent with you, becomes the basis for opinions on how badly you were hurt and what you can still do.
There are also guardrails. Under Ontario’s rules on unfair or deceptive practices, now set out in the Unfair or Deceptive Acts or Practices Rule (FSRA) under the Insurance Act, it is an unfair practice for an insurer, when adjusting or settling a claim, to make a statement it knows or ought to know misrepresents or unfairly presents the findings of a person who conducted a section 44 examination. That rule tells you how these reports can be handled, and it is a reason to check that a decision fairly reflects what the report actually says.
None of this means an examiner is biased or acting in bad faith. It means the report is one opinion, formed in one visit, for a specific purpose, and it should be weighed against everything else on the record. Which is why your own evidence matters as much as it does, and why the next two sections do the real work.
How to prepare and what to bring
The exam is not a conversation with your family doctor, and preparing for it accordingly is the most useful thing you can do.
Before you go, tell your lawyer the moment the notice arrives, not the week of the appointment. For a section 44 exam, confirm the notice actually contains what section 44(5) requires. For a defence medical, the terms, including scope, length, and whether anyone can attend with you, may be set by agreement or by the court, and your lawyer needs time to deal with that. Remind yourself that attending is not the same as agreeing with the findings.
Bring photo identification and the appointment notice. Bring a written list of your current medications and your treatment providers. Bring a short written list of your injuries, your current symptoms, and how they limit your daily activities, in your own words, because it is easy to freeze or leave things out when you are being assessed by a stranger. Bring any assistive device you actually use, a brace or a cane, and use it because you need it, not for show.
During the exam, be accurate and be consistent. Describe your good days and your bad days honestly, without minimising and without exaggerating. Everything you say will be compared against your treating records and, potentially, against surveillance, which is the subject of our companion article. Answer the questions you are asked; you are not there for treatment or for a chat. Note the start and end time and roughly what was done, because a very short exam that produces very confident opinions can be relevant later.
Afterward, the report and decision follow once the insurer receives the report from the examiner. For most common benefits it must send you a copy within 10 business days of getting it. Review the report with your lawyer for factual errors. Where something is wrong, the response comes through your own treating practitioners.
Your own doctors still matter, and here is why
The insurer’s doctor is not the last word, and understanding that changes how you should think about the whole process.
In a lawsuit, the defence medical report does not stand alone. It is weighed by the court against your own medical evidence, including the doctors who have actually been treating you, and both are in front of the decision-maker (the report itself is disclosed under Rule 33.06). In an accident benefits dispute, the Licence Appeal Tribunal weighs the section 44 report against your treating and assessment evidence. A section 44 report is not automatically preferred, and where the insurer’s notice was defective, the Tribunal can limit how much the report is relied on at all.
The practical lesson is simple. The strongest answer to a single-visit examination is a consistent, well-documented treating record. Keep seeing your own providers, report your symptoms to them accurately, and let them build the clinical picture over time. That record is what a decision-maker has to weigh against the opinion of a doctor who saw you once.
What we look for when a client brings us an IME notice
After years of handling these files, the notice itself is the first thing I read closely, because problems there are common and they matter. Here is what I check and what I see go wrong.
The first thing I look at is whether the notice actually gives medical reasons, not just a line saying an examination is required. A notice that does not explain why can be challenged, and clients often do not realise the reasons are supposed to be there at all.
The second is the match between the examiner and the injury. I have seen assessments booked with a specialty that does not fit the problem the client is living with, and that mismatch is worth raising early rather than after the report lands.
The most common mistake I see from injured people is trying to appear either tougher or worse than they are. Clients want to seem stoic, so they downplay a bad week, or they worry they will not be believed, so they overstate. Both hurt, because the report gets compared against months of treating records. The honest, consistent account is the one that holds up.
The other frequent mistake is going quiet with their own doctors once the case starts. That treating record is the single most useful thing a client can build, and it is the first thing I reach for when a section 44 or defence report says something we need to answer.
How this connects to surveillance
The medical exam is one of two tools the other side uses to test your claim. The other is surveillance and social media, and the two are meant to work together: footage or photos that seem to contradict your reported limitations, handed to an examiner or shown at trial.
There are limits on how surveillance can be used. In Iannarella v. Corbett, 2015 ONCA 110 (Court of Appeal for Ontario), the court held that the defence must disclose surveillance through its affidavit of documents and cannot spring undisclosed footage at trial as a form of ambush. Surveillance handed to a defence medical examiner can also waive the privilege the defence would otherwise claim over it. We cover how adjusters and investigators actually use this material, and why your privacy settings are not the shield people assume, in our companion article on surveillance and social media.
Talk to us before your exam
If you have received a notice for an insurer’s examination or a defence medical, the time to get advice is before you attend, not after the report lands. We handle serious injury claims across Ontario and can tell you what the notice actually requires, what to expect from the exam, and how to protect the evidence that matters most, which is your own. Contact MG Law to talk it through.
About the author
Miryam Gorelashvili, LL.B. is the founder of MG Law in Ottawa, where her practice is restricted to clients with serious and catastrophic, life-changing injuries. She has represented injured clients in accident benefits and tort claims across Ontario, including catastrophic impairment claims, and holds an LL.B. from the University of Ottawa. You can read her full bio on the MG Law team page.
References
Statutory Accident Benefits Schedule, O. Reg. 34/10, Government of Ontario, e-Laws.
Rules of Civil Procedure, R.R.O. 1990, Reg. 194, Government of Ontario, e-Laws.
Courts of Justice Act, R.S.O. 1990, c. C.43, Government of Ontario, e-Laws.
Insurance Act, R.S.O. 1990, c. I.8, Government of Ontario, e-Laws.
Cost of Assessments and Examinations Guideline, Financial Services Regulatory Authority of Ontario.
Unfair or Deceptive Acts or Practices Rule, Financial Services Regulatory Authority of Ontario.
Iannarella v. Corbett, 2015 ONCA 110, Court of Appeal for Ontario, CanLII.
Frequently asked questions
Do I have to attend an independent medical examination in Ontario?
It depends which exam it is, and the two work differently. A section 44 insurer’s examination in your accident benefits claim can be required by written notice, and skipping a properly noticed one can bar you from disputing a denied benefit at the Licence Appeal Tribunal. A Rule 33 defence medical in a lawsuit is arranged by agreement or by a court order under section 105 of the Courts of Justice Act. Either way, get advice from your lawyer before you decide anything, and remember that attending is not the same as agreeing with the report.
Who chooses the doctor for an IME in Ontario?
The side that ordered the exam. For a section 44 examination, your insurer picks the examiner. For a Rule 33 defence medical, the defence chooses, subject to the court. In neither case is it your own doctor or a neutral, jointly chosen physician.
Who pays for an independent medical examination?
For a section 44 exam, the insurer arranges it at its expense, capped at $2,000 plus HST per assessment (s.44(5), O. Reg. 34/10). For a Rule 33 defence medical, the defence pays. You should not be out of pocket for either exam itself.
When will I receive the IME report?
It depends on the benefit being assessed, because the timing rules live in the provisions for each benefit rather than in section 44 itself. In many common section 44 situations, the insurer must send you the report within 10 business days of receiving it from the examiner, so the clock runs from when the insurer gets the report, not from your appointment. For an in-person defence medical, Rule 33.06 requires the examiner’s report to be served on the parties, so your side receives it.
Can I record an independent medical examination?
There is no automatic right to record. For a defence medical, whether recording is allowed can be set by agreement between the lawyers or by the court order that arranges the exam, and the same practical approach applies to a section 44 exam. Ask your lawyer first, because raising it in advance is far easier than trying to insist on the day.
Can I bring someone with me to an IME?
Do not assume you can. For a Rule 33 defence medical, the default is that only you, the examining health practitioner, and any assistants the practitioner requires are present, unless the court orders otherwise (Rule 33.05, Rules of Civil Procedure). Where the examination proceeds by consent, the lawyers can agree to different terms. For a section 44 insurer’s examination, ask your lawyer in advance whether a support person can attend. Either way, clear it before the appointment rather than arriving with someone.
What happens if I miss or refuse an insurer’s examination?
For a section 44 exam, non-compliance with a properly noticed examination can bar you from taking a denied benefit to the Licence Appeal Tribunal (s.55, O. Reg. 34/10), though the insurer must first prove its notice met the requirements. For a defence medical, the court can order you to attend. If you cannot make an appointment or have concerns about it, tell your lawyer rather than simply not showing up.
Is the IME doctor my doctor?
No. The examiner has no treating relationship with you and no duty to care for you the way your own physician does. The appointment is an assessment of your claim, not a medical visit, and nothing said in it should be mistaken for treatment or advice about your care.
What if I disagree with what the report says?
Attending the exam never meant agreeing with it. The answer to a report you disagree with is your own evidence: the treating practitioners who know your injury, and, where the section 44 notice or process was flawed, a challenge to how much weight the report should get.
