Know the Law: Insurance Medical Examinations

Suppose you are in a car accident. You struggle to keep up with your own doctors’ appointments. Then you learn that an insurance company or the lawyer hired by the insurance company wants you to be examined by a doctor they have chosen. Wondering: is this allowed? Grand Rapids auto accident attorney Tom Sinas of the law firm Sinas Dramis answers many questions about insurance medical exams for viewers on “Know the Law” this week.

Many people injured in automobile accidents may receive correspondence from their no-fault automobile provider requesting an “independent medical examination” also and more accurately referred to as “insurance medical examinations”.

Section 3151 of the no-fault law provides that where a person’s mental or physical condition is in question, a no-fault insurance company may require the claimant to undergo a “mental or physical examination by physicians.” However, there must be a reasonable explanation as to why the person should do this.

The No-Fault Reform Act of 2019 requires that medical assessments conducted at the request of insurance companies be carried out by physicians with similar specialization as the injured person’s treating physician. Specifically, the new law states that “if care is provided to the person to be examined by a specialist, the medical examiner must specialize in the same specialty as the physician providing the care, and if the physician providing the care is certified in the specialty, the medical examiner must be board certified in that specialty.

The new legislation also provides that in all cases, a medical examiner, during the year preceding the medical evaluation, must have devoted the majority of his time to the act of clinical practice of medicine or to teaching in a medical school or in an accredited residency or clinical research program for physicians.

An applicant who undergoes an insurance medical examination may request a copy of the report. If a claimant refuses to submit to an independent medical examination, a court may make orders appropriate in the circumstances, including prohibiting the claimant from presenting any evidence of their mental or physical condition.

Therefore, claimants should never ignore a request from their insurer to attend an independent medical examination, as an unjustified absence could jeopardize the claim.

To learn more, visit sinasdramis.com or call 616-301-3333.

Sponsored by Sinas Dramis law firm. Information taken from the article provided by the blog of the law firm Sinas Dramis.

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