All too often insurance company doctors attempt to discount the injuries of accident victims. What can occur is the insurance doctor performs a one-time exam of the insured lasting only a few minutes.
Then the insurance friendly doctors will dictate a report, which outlines their cursory examination and their medical opinion. The opinion of the doctor, not surprisingly, invariable assists the insurance in cutting off the insured’s benefits.
These insurance biased opinions typically fall into one of three categories:
- That the person is not injured;
- Is capable of working or,
- That the injuries present are not the result of the automobile accident or work injury but rather some other event.
The next thing the insured knows is that they are receiving a letter from their insurance company termination all of their medical benefits on the basis of this one time evaluation. In the great majority of cases, this one time evaluation and the opinions of the insurance company doctor are in direct conflict with the opinions of the treating physicians who have treated his individual for many months and, in some cases, years and who relate the treatment to the injuries sustained in the traumatic event.
Is this fair? Not even close.
I think the general public would be surprised as to the credentials and background of some of the more infamous doctors used by the insurance industry.
So what can you do to protect yourself from these unscrupulous physicians?
- Realize that not all doctors are this corrupt. The doctors that spend the majority of their practice handling exams for insurance companies are few and far between.
- At the time of your exam, bring along a trained nurse or observer to record the extent of any testing or reporting by the insurance doctor. This will ensure that improperly performed tests are noted and that you have a witness to a physician who claims he performed a test that never occurred.
- If your possible, have a court order prior to the exam that lays out the rules for the exam, including, time, place, duration, invasive procedures, mileage reimbursement, presence of a neutral observer and other exam parameters.
- Know that you must attend. In some states, failure to attend can form basis for termination of certain types of benefits.
- Keep in mind that this doctor works for the insurance company. What you say, will be used against you. Even when he explains that he has been hired as an “independent,” you can expect him to be leaning heavily towards the folks that are paying him.
- Listen to the questions he asks and answer them truthfully without unnecessary elaboration.
- Be honest and precise. Do not exaggerate your injuries.
- Do not volunteer information. Do nut volunteer. Do not discuss who was at fault in the case. Do not discuss any conversations you’ve had with your attorney as these are privileged conversations.
- Let your treating physician know that you are being ordered to an insurance company exam. If your physician can, have him or her examine you on the same day of your insurance exam to make sure the results are consistent.
- Be aware that you may be video-taped going to and from your insurance company exam.
Finally, know that despite your best efforts to be prepared, to be concise, to avoid exaggeration, and the presence of a neutral third party, the report will probably attempt to down play the injuries. If you have followed the above tips, you and your counsel will be in the best possible position to challenge the cutoff and reinstate your benefits