What Is a Compulsory Medical Examination in an Insurance Claim?

Close up of a doctor doing a medical exam on his patient

A compulsory medical examination is an oral and physical examination by a doctor who represents the insurance company on your claim. Some insurance companies refer to these examinations as independent medical examinations but don’t let the name mislead you. These doctors are not independent, as the court does not assign them.  

The doctor contracted for your compulsory medical examination has been hired instead by the insurance company to look after their interests. While the doctors are expected to be objective in their examination, it is feasible for an insurance company to simply shop around for a doctor who consistently finds results the company considers favorable for the type of injury you have. 

How to Prepare for Filing an Insurance Claim

If you’ve been injured and are considering filing an insurance claim, your personal injury lawyer will be able to answer your questions and will be the best resource to ensure your interests are protected. A lawyer will cover many important topics with you prior to your compulsory medical examination, including:

  • What to expect from the compulsory medical exam
  • Preparing for the compulsory exam with your attorney
  • What to say to the examining physician
  • What the examining physician is looking for
  • Record keeping

It is important to discuss these topics prior to the compulsory medical examination to ensure that you do not inadvertently say or do the wrong thing and hurt your chances of receiving compensation.

What to Expect from a Compulsory Medical Examination

The first part of the compulsory medical exam will be oral, where the contract doctor asks questions about the injury and how it is affecting you. He or she may ask you how the injury occurred. It is vital to ask your lawyer in advance which of these questions he or she wants you to answer and how. You may be told not to answer any questions about how the injury happened, and to make sure any answers that you are required to give our short and very specific. Do not elaborate, remember to always be polite during your exam.

The second part of the exam is physical, and the doctor will check the location of any pain you are feeling, along with your range of motion, and any neurological impairment consistent with the type of injury reported, and will be making observations not just on your answers, but also on your demeanor and any signs that you are feeling the pain in the way that you’re describing. It’s important to be factual and not exaggerate the symptoms you’re experiencing during this procedure.

Preparing for the Compulsory Exam With Your Attorney

If you’ve filed a claim for compensation from an insurance company, at some time after the deposition, you will likely be required to submit to a compulsory medical examination. Even if the insurance company calls it an independent medical exam, it is essential to note that the doctor who is performing the exam is doing it under contract by the insurance company. The insurance company may have given them some key actions, behaviors, or words to look out for in order to minimize their responsibility to pay.

The insurance company hires the examining physician to protect their interests, and they are hoping to hire one who will find that your injuries are nonexistent, exaggerated, a pre-existing condition, or in the case of auto accidents, do not meet the legal threshold for recovery. Some doctors specialize in being witnesses for the defense and are well compensated for their work. You are going to be examined by a doctor you did not choose and there may potentially be someone else in the room either recording the examination, or a court reporter recording any statements made. This has the potential to be an uncomfortable situation, and you should make sure that you have prepared in advance with your attorney.

Before your compulsory medical examination, your attorney will want to sit down with you in order to review the treating physician’s findings, your deposition statements, and any other questions you’ve been asked to answer by the insurance company.  The state has specific guidelines for what you are required to say and do, and your lawyer will know the best way to go about complying with any requirements without hurting your own chances of receiving compensation for your injuries.  

What to Say to the Examining Physician

The examining physician may try to establish a rapport with you during the oral portion of the medical exam. It is important to be polite and patient, answering any questions your attorney has instructed you to answer truthfully but without elaboration. Make sure that any answer you give is simple, to the point, and clearly understood by the examiner. You don’t want to give the doctor a negative opinion of you based on a misunderstanding. You also don’t want to give them a reason to believe you are exaggerating the symptoms, as that may negatively impact their opinion regarding your injuries. Likewise, you should make sure that you’re not including any unrelated pains or complaints while describing your injury and how it has affected you. 

It will be essential to remember exactly how you answered questions during the deposition regarding your injury, and any pain or disability it has caused you so that you can answer the medical examiner’s questions accurately. Your personal injury attorney will you navigate through this complicated process and will coach you on the best way to truthfully answer any questions you are asked and also required to answer. Your lawyer will also tell you which questions may impact how insurance companies calculate settlements and which do not need to be answered by you at this time.

What the Examining Physician Is Looking for

You should expect the insurance company to have an investigator or the examining physician watching you throughout this process. They may have an investigator watch you as you leave your home or job, and enter the building. Once you check in, the examining doctor may watch as you sit and wait for the appointment, get on and off of the examining table, and your demeanor or facial expressions throughout. They will be looking for inconsistencies between what your stated pain and limitations are and what they believe you are actually feeling. The doctor will be using the exam to form and refine an opinion on your condition throughout the entire process.  

The examining doctor will also have access to any prior medical records, security recordings, or any other material that the insurance company feels might sway the opinion in their favor. The compulsory medical exam performed by the doctor and resulting report may be used as a tool by the insurance company to justify offering less or even nothing in the form of compensation, and to determine if and how health insurance covers car accident injuries. If your case goes to trial, it’s vital to remember that the doctor that was contracted to perform the compulsory exam will likely be a willing and skillful witness for the defense. It’s important that you follow your attorney’s advice as closely as possible during the exam so that he or she has the tools and strategy in place to counter the doctor’s testimony. Your lawyer may even have you schedule an appointment with your treating physician on the same day as the compulsory medical examination. In this way, he or she can offer an alternative medical professional’s opinion of your condition within the same time period that the defense witness formed theirs. 

Ask your personal injury attorney about whether there is going to be someone recording the exam. It is sometimes helpful to have a recording of the procedure if it becomes necessary to refute an observation the examiner believes to be factual. These are skilled professionals, and they know what to look for to support their opinions about your condition. They also know how to testify so that their opinions are given greater weight. It could be important to have visual evidence that calls any incorrect observation or opinion into question. Your personal injury attorney is going to be your advocate throughout this long and potentially frustrating process, so make sure that you sit down and discuss strategy with them before you go. Doing so will give them the tools to do an effective job on your behalf.

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