Can Insurer Send You to Their Medical Examiner?

There is a general right on insurers to obtain professional advices. Clause (5) of the Special Provisions states:


The insurer has the right and the claimant shall afford to the insurer, an opportunity to examine the person of the insured person when and as often as it reasonably requires while the claim is pending, and also, in the case of the death of the insured person, to make an autopsy subject to the law relating to autopsies.

Evidently, “the insurance company has a legitimate self-interest in determining that it is making payments for measures that are remedying a situation for which the accident in question was the cause”: Lamrock, supra para 18. That interest applies to the medical and loss of income benefits: Veno, supra para 109. However, as stated in the provision, the insurer must act ‘reasonably’. Compelling injured persons to travel outside of the province for an examination is questionable: Wheaton v. Mellish (1989), 103 NBR (2d) 271 (QB); Perreault v. Ramsay (1994), 150 NBR (2d) 91 (CA). Furthermore, when the insurer exercises its right, “one would expect the choice [of the examiner] to be that of a specialist in the nature of injury suffered by the insured” (Lamrock, supra para 20) but is not necessary that the examiner be a physician (Veno, supra paras 103-110). Grounds that may justify an objection to an examination are risky or painful invasive procedures, the extent of any hardship or inconvenience suffered, the qualifications of the examiner, or a prior bad experience with the professional: LeClerc v. Sunbury Transport Ltd (1992), 124 NBR (2D) 433 PARA 15 (CA).

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