If a car is insured in the State of Oregon, it must carry Personal Injury Protection benefits, which provide medical, disability, domestic service and child care benefits. The auto insurer providing personal injury protection benefits, aka PIP benefits, has a right to manage the claim, and determine whether medical care is actually necessary.
One way that a PIP carrier manages these claims is through “independent medical examinations.” Under the insurance policy, the PIP carrier can require, if it is reasonable, that its insured attend an independent medical examination. This is a medical examination performed by a doctor chosen by the insurance company to determine what care is necessary, if at all. Based on the opinion of the independent medical examiner, the PIP carrier may terminate payment of medical benefits, or continue medical benefits as recommended. If there is a disagreement, the insured can seek arbitration, or file a complaint in state court.
If this request is reasonable, then the insured is required to attend the examination if he or she wants to continue seeking benefits under the insurance policy. If the insured decides not to attend the examination, then the insurance company can terminate benefits, citing the insured’s failure to cooperate as required under the contract.
In some cases, we may advise our client not to attend the independent medical examination. Some independent medical examination physicians have reputations that precede them, and are notorious for a strong bias against the injured motorist. Other medical examiners tend to be more objective, and if the injured motorist truly needs further medical care, these reasonable and objective medical examiners will say so.
There are a lot of factors to consider when deciding whether to attend or not attend an independent medical examination. First, does the injured motorist have other health insurance that will cover the cost of necessary medical care? Second, even if the injured motorist attends the examination, will be attending physician who is actually treating the injury sustained in the car collision be willing to step up and oppose or disagree with the findings and the independent medical examination? Another consideration is how the independent medical examination may affect the claim against the responsible motorist and its insurance company.
Our experience is that whether to attend an independent medical examination is very much dependent on the specific facts of each case, and our client's specific situation. There are no easy answers, because in the end, nobody really knows exactly what the outcome of one of these examinations may yield, but we can provide some pretty good insight on some of the medical providers that perform these examinations for insurance companies.
If you are dealing with a motor vehicle collision injury in Oregon or Washington, and you have questions about whether to attend a personal injury protection medical examination, call us at 503-325-8600. We can discuss the many factors that go into deciding whether you should go are not go to these exams.