How to Protect Your Rights When a Long-Term Disability Insurer Requests a Medical Exam

You know that you have a long-term disability. Your doctors know that you have a long-term disability. Yet, before the insurance company is willing to acknowledge that you have a long-term disability, it wants you to go for a medical exam with a doctor of its choosing. This can, understandably, make you nervous and uncomfortable. It may also leave you with a lot of questions—many of which we will address in this blog post.

Can the Insurance Company Request That You Attend a Medical Exam With Its Own Doctors?

Generally, the answer is yes. The specific answer will depend on the exact language in your long-term disability benefits insurance contract. Since most insurance companies recognize that the terms of the contract are important, most insurance companies include specific language that makes your receipt of benefits dependent upon your cooperation with their investigation into your long-term disability. This investigation often gives the insurance company the option of requesting a medical exam scheduled with a doctor of its choosing.

Do I Have to Go to the Insurance Company’s Medical Exam?

Yes, if the insurance contract allows the insurance company to request an independent medical exam then you must comply with the insurance company’s request. If you fail to do so, then you may be in violation of the contract and the insurance company may deny your long-term disability claim.

What Can I Do to Protect Myself If I Go to a Medical Exam?

You are right to be cautious about trusting the doctor the insurance company chose to examine you. While the insurance company may call the exam an “independent medical exam,” the exam is not really independent.

What You Need to Know About Long-Term Disability and Medical ExamsThe insurance company’s goal is to pay you as little as possible for your claim, and the insurance company chose the doctor with this goal in mind. The doctor knows this and likely wants continued business from the insurance company. Therefore, the doctor may be less objective than an independent physician.

However, any doctor who examines you—even if that examination is at the request of the insurance company—owes you a duty of care. That means that the doctor should be concerned with a proper diagnosis and, if appropriate, treatment plan rather than the effect of his report on your insurance claim.

That said, there are specific steps that you can take to protect your rights. Specifically, you can:

  • Bring someone with you to the exam. This person should remain in the room with you to witness the entire examination, so be sure to pick someone with whom you are comfortable.
  • If the doctor says something with which you disagree, ask that your disagreement be documented in his notes. For example, if the doctor says that you are exaggerating your symptoms or malingering, then ask that your disagreement with that assessment be written in the doctor’s notes.
  • Ask to see any notes or documents that the doctor completes before you leave the appointment. That way you can check them for accuracy and try to resolve any differences before you leave the office. The doctor may not give them to you, but it does not hurt to try.
  • Write down everything that you remember from the exam immediately after the appointment. These contemporaneous notes may be important evidence later.

You have a lot at stake, and you deserve to get the long-term disability to which you are contractually entitled. The insurance company won’t make that easy, however. For this reason, you should always consult with an experienced long-term disability insurance lawyer who will make sure that all of your rights are protected.

Do You Have Additional Questions?

Contact us before your claim is denied. From the beginning, we can make sure that the insurance company honors its contractual obligations, that you are treated fairly, and that all applicable deadlines are met.

Since 1994, we have been helping people with disabilities. Let us help you. Call us or contact us via this website at any time to schedule your free, no-obligation consultation with one of our experienced disability attorneys and start getting your questions answered.

 

John L. Keefe
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Founding Attorney, Massachusetts Social Security Disability Lawyer
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