Independent Medical Evaluations: Important Information For Insurance Companies

Posted on

If you own or manage an insurance company, you will deal with a variety of claims. In some cases, claims may be filed for personal injury cases or workers' compensation cases. When your insurance company receives a claim that involves an injury, it is important to have as much information as possible so the right decisions regarding the claim can be made. The claimant may submit information from their personal doctors, but as an insurance company, you have the right to request an independent medical exam. An independent medical exam can present important information about a claim, but it needs to be done properly. Use the following tips to help you utilize an independent medical evaluation.

Choose a Physician Carefully

When it comes to independent medical exams, an insurance company is allowed to choose the doctor who will perform the exam on the claimant. Thus, the burden is on your company to select a highly qualified physician who will provide accurate medical information after performing a thorough exam. While an independent medical exam can be a useful tool for an insurance company, selecting the right physician is essential. You need to make sure that the physician selected to do the exam is unbiased and an expert in their field. Take your time selecting a physician that can perform the exam and provide an in-depth report. 

Don't Forget to Submit the Claimant's Medical Records

Since an independent medical exam is requested by an insurance company, you will be responsible for ensuring that the physician performing the exam has all of the information that they need in advance—the claimant is not responsible for scheduling the exam or submitting medical records in advance. As an insurance company, you will have the medical records sent to you by the claimant, and you will need to submit these records to the physician so they can see the initial diagnosis and treatment plan recommended by the claimant's physician.

Follow All Rules

Laws pertaining to insurance companies and independent medical exams can vary from state to state. It is extremely important that your insurance company understands the laws and follows all of them. For example, some states require that an insurance company contact a claimant in writing to request an independent medical exam a certain number of days before the appointment. If you do not follow all of the rules, the information found during the independent medical exam may be thrown out by a judge if the claim goes to court.