Why is my insurance company telling me which doctor to see?

When your insurance company wants to book a physical examination with their own doctor, it’s called an insurer’s assessment or examination. The purpose of these examinations is to verify whether you have been truthful in describing your health conditions, both before and after the accident. If you are being asked to undergo an insurer’s examination, it is advisable that you consult with your Toronto injury lawyers prior to the exam to make sure that your attendance is truly required, and if so, that the insurance company has provided you with proper notice and considerations.

Is an Insurer’s Medical Exam Necessary?

This is a question that Toronto injury lawyers hear often. When an accident victim has already been to see their own doctor, it is natural for them to wonder why an insurance company would put them through the added inconvenience of going for yet another examination. When the victim is already starting to feel the pinch of financial hardship resulting from the injury, they may even wonder if the insurer’s physician is going to give them a fair assessment.

In Ontario, insurers have the right to request one or more medical examinations of claimants provided that their requests are “reasonably necessary” for them to determine whether or not to pay on a claim.

As “reasonably necessary” can be a bit vague, your insurance company is required to provide you with an Explanation of Benefits as well as with the reason that they are requesting the examination.

But before attending the examination, you should always consult with your personal injury lawyer.

As your injury lawyers, Clarke Law can help you prepare for and know what to expect during an insurer’s medical examination with a doctor hired by the insurance company. We can also help you dispute any findings that are unfair (after all, this is an examination that is being paid for by the insurance company!)

During the Insurer’s Medical Examination (“IME”)

If after consulting with your lawyer, it is determined that your insurance company is in compliance with all the proper regulations in requiring the examination, you will be required to attend the examination in order to determine if the benefits being applied for are reasonable and necessary.

No matter what, it is always best to be honest during the examination. If there are inconsistencies between your claim and what you tell the doctor, it could very likely lead to delays in your claim being processed – or if your insurance company thinks that you are being deceptive or misleading, your claim may be denied.

After the IME

Follow the one or more examinations requested by your insurance company, the physician will submit a report to the insurance company which may or may not be favourable to your claim. Your personal injury lawyer can let you know whether or not she thinks the report or any offered compensation is fair.

If the compensation that is offered is not fair, we can proceed with further legal action by filing an application for mediation and further for an arbitration determination.

When insurance companies insist that you see one of their doctors, they may be within their rights to do so. Having a team of Toronto injury lawyers on your side is important to make sure that you are treated fairly at any insurer examination.

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