Why is the Insurance Company Sending me to an Independent Medical Assessment?

Why is the Insurance Company Sending me to an Independent Medical Assessment?

At Share Lawyers, we often get asked by our clients why their insurance companies are sending them for an independent medical assessment. Many of us have never come across the term independent medical examination (IME) before, and need clarification about what it is, and why it happens. 

IMEs exist to provide an unbiased medical examination for evidence in legal matters. Most often, these occur in cases related to disability, personal injury and motor vehicle accidents. 

It is specifically conducted by a medical professional who has never previously offered care to the individual.

“Under most insurance policies there is a requirement that allows the insurance company to request that someone attends an assessment with a doctor of the insurance company’s choosing,” explains Brad Pleavin, a lawyer with Share Lawyers. “Insurance companies use these medical assessments as part of their adjudication. It helps them to make a decision with respect to the claim.” 

A party will request an IME in order to get a medical report that supports their desired outcome. While the medical professional chosen by the insurance company must be qualified, it may be quite stressful for those seeking disability benefits because not all doctors agree on diagnoses. Insurance companies will often use the same doctors that they have used in the past, in hopes of having a level of control over the medical findings. Medical professionals who may be asked to complete the assessment include family physicians, specialists, chiropractors, physiotherapists, psychiatrists and psychologists.

The Canadian Medical Protective Association outlines some of the differences between the traditional doctor-patient relationship, and the physician’s role in an IME. “An IME usually does not give rise to a traditional doctor-patient relationship. The doctor has been retained by a third party to perform an evaluation and render an independent opinion. The physician is not there to treat or act as an intermediary. This should be explained to the person who is to be evaluated.”

While no person can be forced to undergo a medical assessment, the consequences of refusing can be devastating. In situations where the insurance company continues to pay benefits, not attending an assessment can be seen as non-cooperative behaviour, leading to a suspension of benefits. If your claim has already been denied and you are not receiving benefits, declining an assessment will have little effect. This decision should always be made with your lawyer.

If you are unsure about your rights in a situation where you are asked to seek a medical evaluation, we encourage you to reach out to Share Lawyers today.

Has your long-term disability claim been denied? Contact Share Lawyers and put our experience to work for you. We have recently settled cases against Manulife, Fenchurch, La Capitale, Equitable Life, Cigna, Sun Life, and many more. We offer free consultations and there are no fees unless we win your case. Find out if you have a disability case.