Assessement of medical


#1

When an insurance company is reguest an independent medical assssment what does that entail and does that mean they are looking for a denial of claim


#2

It means seeing someone on their payroll so they can find a way to deny your claim.
I’m sure you’ll get comments from people that have been through it (I haven’t).
Good luck.


#3

Under the terms of the policy, the insurance company has a right to have you examined by a doctor of their choosing. Almost all people who are on an approved disability claim will attend one of these examinations at some point. The purpose of these assessments is to get an opinion on your diagnosis, quality of your current treatment, prognosis, etc. It is not fair to say the insurance companies always do these assessment with bad intent. I have seen these assessments go in the insured person’s favour many times. I have seen situations where the insurers will order these assessments if they believe you are disabled, but the medical information from your doctor is not good. The need more comprehensive information for them to justify the approval to their superiors. On the other hand, there is no doubt( in my experience) that insurance companies will rely on the medical examinations to deny a claim. Some are likely done with bad intent. I have been involved in hundreds of cases, maybe thousands at this point. and I can tell you that there is not always ill intent. Either way, you have an obligation under the policy to attend these appointments, so refusing to go would violate the terms of the policy and give them grounds to deny the claim or stop payments.


David Brannen

Disability Lawyer with Resolute Legal

The response posted above is based on the limited factual information made available and is not intended as a full and complete response to the question. The only reliable manner to obtain complete and adequate legal advice is to consult with a lawyer, fully explain your situation, and allow the lawyer enough time to research the applicable law and facts required to give an adequate opinion. The basic information provided above is intended as a public service only, a full one-on-one discussion with a lawyer should be done before taking any any action. The information posted on this forum is available to the viewing public and is not intended to create a lawyer client relationship with any person. If you want one-on-one advice, please click here to request a free consultation or call toll free 1-877-282-5188 to speak with a member with our disability claim support team.


#4

I agree that not all are done with bad intent, and not all specialists or treatment providers would proceed that way. I would ask that any forms required to be filled out prior to an assessment be forwarded to you before the appointment and to not go alone.

Sometimes Case Managers or the Insurers want more medical proof and then will ask you to apply for CPP-D.

Trust your gut–if you feel that something is not right–then you may want to see a lawyer.