Pillsbury & Coleman, LLP
We Can Help You. 415-655-1549
Toll Free: 866-460-7279

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
Email Our Attorneys

We Can Help You

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

  • American Board of Trial Advocates
    American Board of Trial Advocates A prestigious national association of experienced trial lawyers and judges. Membership is by exclusive invitation only. All members shall have completed 10 civil jury trials to jury verdict or hung jury as lead counsel.
  • Best Lawyers
    Best Lawyers The oldest and most respected peer-review publication in the legal profession. A listing in Best Lawyers is widely regarded by both clients and legal professionals as a significant honor, conferred on a lawyer by his or her peers.
  • AV | PeerReviewRated | Martindale-Hubbell | For Ethical Standards and Legal Ability
    Martindale-Hubbell Peer Review Ratings An objective peer review rating indicator of a lawyer's high ethical standards and professional ability, generated from evaluations of lawyers by other members of the bar and the judiciary. Pillsbury & Coleman founding partner Philip L. Pillsbury Jr. is rated “AV Preeminent.”
  • Super Lawyers
    Super Lawyers A peer-review rating service of outstanding lawyers from more than 70 practice areas who have attained a high-degree of peer recognition and professional achievement.
  • Best Lawyers | Best Law Firms | U.S.News & World Report | 2018
    Best Lawyers Best Law Firms U.S. News 2017
  • American Association for Justice | Formerly the Association of Trial Lawyers of America (ATLA)
    American Association for Justice (AAJ) Founded in 1946, AAJ is the world’s largest trial bar and supports the work of attorneys to ensure that injured plaintiffs can obtain justice.
  • IACCEC
    American College of Coverage and Extracontractual Counsel Composed of preeminent insurance coverage counsel in the United States and Canada, representing the interests of both insurers and policyholders. The minimum membership requirement is the practice of insurance law for at least fifteen consecutive years.
  • Association of Business Trial Lawyers | abtl
    Association of Business Trial Lawyers Founded in 1972, ABTL is dedicated to connecting litigators and judges to address issues important to trial lawyers.
  • Consumer Attorneys of California
    Consumer Attorneys of California The only California-wide unified trial bar for plaintiffs lawyers who represent consumers harmed by powerful foes such as insurance companies, pharmaceutical companies, automobile manufacturers and banks.
  • SFTLA | San Francisco Trial Lawyers Association
    San Francisco Trial Lawyers Association For over 60 years, this prestigious bar association has educated and trained trial lawyers and supported and passed critical legislation to protect and advance individuals’ rights.
  • United Policyholders | Empowering the Insured
    United Policyholders A non-profit group dedicated to providing trustworthy and useful information and an effective voice for insurance consumers in all 50 states.
  • America's Top 100 High Stakes Litigators | 2018 | Top 100
    ACCEC | American College of Coverage and Extracontractual Counsel | Fellow