A letter arrives asking you to attend an assessment with a doctor you have never heard of, at a clinic across the city, on a date the insurer has chosen. It says the assessment is required. It may also say that if you do not attend, your benefits may be suspended.
This is an independent medical examination, and it is one of the moments in a personal injury claim where what you do matters most. Here is what it is, what your obligations are, and how to approach it.
Two kinds of examination
There are two situations in which an insurer can require you to be examined by a health professional of its choosing.
Accident benefits. Your own insurer, paying accident benefits, may require an examination to decide whether you are entitled to a benefit, whether treatment is reasonable and necessary, or how your injury should be classified. The regulation sets rules for these: the insurer must give notice explaining the purpose, the assessor must be qualified in the relevant discipline, and the examination must be reasonably necessary. The insurer must provide the report to you afterward.
The tort claim. If you have sued the at-fault driver, or the owner of the property where you fell, the defendant’s insurer may require you to be examined by a health professional as part of the lawsuit. This is a defence medical, and it is allowed by the court rules because you have put your health in issue by claiming damages. The defendant is usually entitled to one examination per relevant discipline, and the report is disclosed.
Both are described as independent. In practice the assessor is selected and paid by the insurer, and the report is written for the insurer. The assessor is not your treating doctor.
Do I have to go?
Generally, yes. For accident benefits, refusing to attend a properly requested examination allows the insurer to suspend the benefit until you do. For the tort claim, refusing can lead to a court order and to costs. There are limits: the request must comply with the rules, the assessor must be appropriate, the notice must be adequate, and the number and scope of examinations must be reasonable. A lawyer can object to a request that oversteps, and can negotiate the terms. But the starting point is that attendance is expected.
What to expect
The examination usually has three parts. The assessor reviews your records before you arrive. They then interview you about the accident, your symptoms, your history, and your daily activities. Finally, they examine you, which may involve physical testing, range of motion measurements, questionnaires, or, for psychological assessments, standardised tests.
Some examinations are brief. Others take several hours. You may be observed from the moment you arrive at the building, and the report may comment on how you walked in, how you sat, and how you moved in the waiting room.
How to conduct yourself
- Be accurate. Describe your symptoms as they actually are, on a typical day, not on your best day and not on your worst. Do not minimise because you want to appear stoic, and do not overstate because you fear being disbelieved. Assessors are trained to detect both, and either will be noted.
- Be consistent. The assessor will have your medical records and may have your statements from the accident benefits file or the lawsuit. An account that departs from those records is the most damaging thing that can come out of an examination.
- Do not guess. If you do not know or do not remember, say so.
- Do not volunteer opinions. You are there to describe your condition, not to argue about causation, your job prospects, or your claim.
- Note the details. Afterward, write down how long the assessment took, what was examined, and anything that seemed incomplete or inaccurate. If the report later says the examination lasted an hour and it lasted twenty minutes, your note is the evidence.
You may bring someone with you for support. You may generally not record the examination without agreement.
After the report
The report will go to the insurer and, in due course, to you. It is common for it to conclude that your injuries are less serious than your treating providers believe, or that you have recovered. That conclusion is one opinion. It can be answered with the opinions of your treating providers, with your own assessment if needed, and with the record of your treatment and symptoms over time.
A negative report is the beginning of a dispute, not the end of the claim. Our post on long-term disability denials covers a related process, and our post on accident benefits and the tort claim explains how the two files interact.
For more on how we handle these claims, see our motor vehicle accidents and disability benefits pages. If you have received a request to attend an insurer’s examination, book a consultation with Kabir & Alam Lawyers before you go.