The Law Center

Insurance Company Medical Exam Do’s and Don’ts

You sustained a work injury and disability and you’re receiving workers compensation.  You get a letter from your employer’s insurance company saying you have to see an independent doctor.   What do you need to know, and what should you do?  Most of the tips suggested in this article apply to anyone who must be examined by an “independent physician” for any type of legal matter.

The first thing you should do is contact an attorney immediately.  Most should offer a free consultation. When you need to visit doctor that you don’t want to see for a legal reason, workers’ compensation or otherwise: that doctor is NOT independent.  The doctor is a defense doctor examining you on behalf of the insurance company, business, or other institution who’s being paid to challenge your right to benefits.

The interview you’re about to have with the doctor is as important as cross examination in a court room.  The things that you do and say can be used against you.   Assume that the doctor has been trained as an expert witness, and you should be aware of about how to protect your right to your benefits and your interests.  When you receive a letter scheduling you for an exam with a non-treating doctor, consult an attorney right away.

Here’s a list of other do’s and don’ts to keep in mind during the examination process:

First, keep in mind the nature of the “defense exam.”  Even though you’re going into a medical office or hospital, the doctor is not there to treat you.  The doctor is a defense forensic witness.   Even if the doctor is personable, warm, and friendly with a great bedside manner, make no mistake – that doctor has a job to do. We have an adversarial legal system and th doctor is paid to play devil’s advocate; he/she must provide a different perspective that your treating doctors.   You’re in litigation – don’t engage in unnecessary conversation.

Second, when communicating your symptoms from the injury, be specific and thorough without exaggerating.   Try not to use general, global language about body parts, but be precise as you can. For instance, stay away from, “the pain is all over.”  “I feel pain everywhere in my entire body.”  That’s unspecific and not helpful.   It’s better to be specific: “I feel a sharp, stabbing, pain in the left side of my lower back, with pain radiating down the back of my right leg, down the outside of my calf, all the way into my toes.”  That is more helpful.  The doctor can criticize over-general and less specific complaints and use it as ammunition against you.

Be thorough.  If you have occasional, muscle contraction headaches but they aren’t as serous as your neck pain, don’ t forget to mention the headaches.   Also remember to mention that you injured different parts of the body which might have recovered, but were part of the initial injury. 

Third, admit when you feel better if you’ve improved since the initial injury date.  If you have good days where pain is much less, admit it.  You don’t score points if you are always complaining of extreme, intense, agonizing pain if it doesn’t appear in your medical records.  You are much more credible admitting that you have good days and bad days and can function sometimes better than other times, rather than being overly dramatic.  

Fourth, answer only the question asked and don’t volunteer information.  If you feel pain or discomfort during the exam, say so.  Don’t expect the doctor to be a mind reader.  If the doctor is doing something very minor like gently touching on the surface of skin at a spot where you typically have pain, don’t exaggerate by saying that a light touch is eliciting intense pain.

Fifth, assume that the doctor is watching you out of the office window as you approach his office as you get out of the car to the moment that you leave his office.  The evaluation happens beyond when the doctor is interacting with you.   For instance, walking into the exam room, down the hall, bending over to pick up something off of the floor, or taking your shoes on and off.  If you have trouble putting your shoes on, wear slip- ons. 

Sixth, have a friend or family member come with you to the doctor’s exam, if possible.   Have someone drive you, especially when the doctor‘s office is a long distance away so you don’t over-represent your ability to drive long distances or commutes.   The other person can also act as a witness to record what time you arrived at the doctor’s office, when you were taken into the examination room, how long the examination lasted, or anything unusual that happened.

Finally, be polite, courteous, and on time.  If you are angry, emotional, and bitter about the entire process, don’t take it out on the doctor or staff.   They’re just doing their job. 

If you must go to a doctor’s appointment by an insurance company doctor and you are NOT represented by an attorney, click the “Request Consultation” button for a free case evaluation.