Insurance Medical Examination

Posted Monday, May 10, 2010 by Ed Harper

Are you presently representing yourself in a bodily injury claim? Have you been told by a third-party (the “at-fault “insurance company) adjuster that you must submit to a medical examination prior to payment of your claim? If the answer to either of those questions is yes, you are at risk for losing out on your ability to properly present a claim for personal injury.

Adjusters are quite savvy and have a knack for making it seem as though they are concerned about you and your claim. Third-party adjusters are well-trained in protecting the interests of the company rather than yours. There is no fiduciary or financial duty owed to a claimant, and in fact, it is assumed the claimant knows there is an adversarial relationship. Therefore, the Latin phrase – “caveat emptor” – should be considered in dealing with anadjuster. Caveat emptor – or “Buyer Beware” – is used anytime one enters into a contract, and also when one is dealing with an adversarial insurance company.

Adjusters will often take advantage of un-represented individuals/claimants and persuade them to allow an examination to take place by a health care provider chosen by the insurance company. The exam will be labeled an “independent medical examination” (IME), but it is far from “independent.”

This exam is otherwise classically known as a “defense medical examination” (DME) because what typically occurs in these exams is that an injured claimant is found without any ongoing need for any further medical care. Maximum medical improvement (MMI) is determined by this defense examiner. However, this one-sided view from an insurance funded exam is typically for purposes of denying, delaying, and defending the claim.

Unfettered access to one’s medical records will occur first, and will be claimed as a necessity before the selected health care provider can perform the examination. So what has occurred is a two-fold danger. First, the insurer obtains complete access to your medical records, and second, a doctor of their choosing is selected to minimize the validity of your claim. Third-party adjusters know this a tremendous advantage for them with respect to their evaluation of a claim, and a claim should not be minimized in this manner.

Injured persons should seek legal assistance as soon as practical to avoid any (or further) damage to their claim. We at Harper Law are here to help. We will answer your legal questions quickly and easily. The initial consultation is free, and should you elect to utilize our services, there are no attorney fees until the conclusion of the case.

We Are Here to Help

Although our office does not handle all types of cases, we hope you will contact us regarding any legal issues you may encounter. We will answer your questions, or refer you to another quality and trustworthy attorney if we are unable to assist you.