Pillsbury & Coleman, LLP
We can help you, call or email us today
415.655.1549
or toll free 866.460.7279

Over Two Decades Of Holding Insurance Companies Accountable

Tips for Attending an Insurance Company's "Independent" Medical Examination

If you find yourself unable to work due to an injury or illness, the last thought on your mind is submitting to an insurance company's demand to be examined by a doctor you've never met.  Insurers refer to these events as "Independent Medical Examinations," although under the circumstances they are anything but independent.  The "independent" doctor is selected by the insurer, derives income directly from the insurer, and depends on the insurer for future business.

Unfortunately, it is not uncommon for a doctor hired by an insurance company to contradict an insured's treating doctors or ignore medical evidence that supports disability.  The outcome of these biased examinations is usually a report recommending against disability, favorable only to the insurance company.

What allows an insurance company to require an insured to attend these sham examinations?  Most disability policies contain language that creates for the insurer a contractual right to predicate receipt of benefits upon attending such an examination.

Consider the following language taken verbatim from a group disability policy issued by a large international insurance company:

PHYSICAL EXAMINATION AND AUTOPSY: We will, at our expense, have the right to have a Claimant interviewed and/or examined:

(1) physically;

(2) psychologically; and/or

(3) psychiatrically;

to determine the existence of any Total Disability which is the basis for a claim. This right may be used as often as it is reasonably required while a claim is pending.

Generally, you must attend this examination even though the "independent" doctor hired by the insurance company will likely be biased against you from the start.  In any event, here are a few tips as you prepare for your examination.

  • Take someone with you to the examination. -- This person should be with you in the examination room and should take notes in case he or she needs to be a witness or provide a statement.
  • Have someone drive you to the appointment. -- The doctor will ask whether you drove to the doctor's office.  Depending on your illness or injury, the insurance company will often cite the ability to drive to the appointment as a reason to deny benefits, even if it's not true (e.g. "you are well enough to drive to the doctor, therefore you are well enough to work").
  • Record the examination. -- Depending on where the examination takes place, you may have a legal right to videotape or record audio of your exam.  If benefits are denied, a recording can be crucial.  We recently had a case where our client recorded his examination, and while the insurance company doctor agreed on tape that our client would not be able to perform his occupation under the influence of his daily pain medicine, the doctor's written report concluded our client was not precluded from working full-time and thus not entitled to benefits.  Ultimately, our client's benefits were paid.

Be advised that a doctor's staff may observe you as well, and report their findings to the reviewing doctor.  Most often this occurs in the reception area. 

If you have any questions about insurance company examinations, you should contact an experienced insurance law attorney for advice.

No Comments

Leave a comment
Comment Information

Visit Our Video Center

Email Us For A Response

Contact Us

Bold labels are required.

Contact Information
disclaimer.

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

close

Privacy Policy

Phone Number

PILLSBURY & COLEMAN, LLP

600 Montgomery Street
Suite 3100
San Francisco, CA 94111

Phone: 415-655-1549
Phone: 415-433-8000
Phone: 415-655-1549
Fax: 415-433-4816
Map & Directions

Connect With Us Online