Can an Insurer Send You to Their Medical Examiner?

When you make a claim on your insurance, you might wonder if the insurance company can force you to see their own medical examiner. Here’s a simple explanation of your rights and what to expect.

What Does the Insurance Company Have the Right to Do?

Insurance companies have a right to check on the claims they are paying for. This means they can ask to see medical reports and, if needed, have you examined by a doctor they choose. This is laid out in a rule that says: “The insurer can have the person making the claim examined by a doctor whenever they want while the claim is being reviewed, and if the person has died, they can perform an autopsy as allowed by law.” This rule is meant to ensure that the insurance company is only paying for claims that are valid and that the treatment or benefits you’re receiving are necessary and related to the claim.

What Does “Reasonable” Mean in This Context?

Even though insurance companies can ask for these exams, they must do so in a “reasonable” way. Here’s what that means:

1. Travel and Convenience: If the insurance company wants you to travel far away for an exam, it might be considered unreasonable. You shouldn’t have to endure unnecessary hardship just to comply with their requests.
2. Choosing the Right Doctor: Ideally, the doctor should be a specialist who knows about your specific injury or condition. While it’s expected they should be an expert, it’s not always necessary for them to be a physician.
3. Valid Reasons to Object: There are good reasons to say no to an exam:
   • Painful Procedures: If the exam involves something painful or risky, you can object.
   • Hardship: If it’s going to be a huge inconvenience for you, like traveling a long distance, you can raise concerns.
   • Doctor’s Qualifications: If you have doubts about the doctor’s qualifications, you can question it.
   • Past Bad Experiences: If you’ve had bad experiences with the examiner before, it’s a valid concern.

What Should You Do If You Need to See Their Examiner?

If you’re asked to see an insurance company’s examiner, keep these tips in mind:

1. Check the Doctor’s Qualifications: Make sure the doctor is qualified to deal with your specific condition.
2. Know Your Rights: Understand what you’re entitled to and what the insurance company can and cannot ask of you.
3. Keep Records: Document everything about the process, including any instructions and your experience during the exam.
4. Get Legal Help If Needed: If you think the insurance company is being unfair or unreasonable, talk to a lawyer who can help you navigate any issues.

In summary, yes, an insurance company can ask you to see their own medical examiner, but they have to do it reasonably. They should not make unreasonable demands or cause unnecessary inconvenience. Knowing your rights and understanding the process can help you handle these situations more easily.