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Know the Law: Insurance Medical Exams

Posted at 10:50 AM, Mar 28, 2022
and last updated 2022-03-28 10:50:47-04

Suppose you are in a car crash. You are scrambling to keep up with your own doctors’ appointments. Then you learn that an insurance company or the lawyer hired by the insurance company is requesting that you attend an examination by a doctor they have selected. You wonder: is this allowed? Grand Rapids car crash attorney, Tom Sinas of Sinas Dramis Law Firm breaks down many questions regarding insurance medical examinations for viewers this week on “Know the Law.”

Many people injured in auto accidents may receive correspondence from their auto no-fault provider requesting an “independent medical examination” also and more accurately known as “insurance medical examinations.”

Section 3151 of the No-Fault Act provides that when the mental or physical condition of a person is at issue, a no-fault insurance company can request to have the claimant undergo a “mental or physical examination by physicians.” However, there must be a reasonable explanation as to why the person must have this done.

The 2019 no-fault reform legislation requires that medical evaluations performed at the request of insurance companies be performed by physicians with specialization similar to those of the injured person’s treating physician. Specifically, the new statute states, “If care is being provided to the person to be examined by a specialist, the examining physician must specialize in the same specialty as the physician providing the care, and if the physician providing the care is board certified in the specialty, the examining physician must be board certified in that specialty.”

The new legislation also provides that in all cases, an examining physician, during the year prior to the medical evaluation, must have devoted a majority of his or her time to the act of clinical practice of medicine or to teaching in a medical school or in an accredited residency or clinical research program for physicians.

A claimant who undergoes an insurance medical examination may request a copy of the report. If a claimant refuses to submit to an independent medical examination, a court can issue orders that are appropriate under the circumstances, including prohibiting the claimant from introducing any evidence of his or her mental or physical condition.

Therefore, claimants should never ignore a request from their insurer to appear for an independent medical examination, as an unjustified failure to appear could jeopardize the claim.

To learn more, visit sinasdramis.comor call 616-301-3333.

Sponsored by Sinas Dramis Law Firm. Information from the article provided by Sinas Dramis Law Firm Blog.