Examinations by Insurance Company Doctors
You might have received a phone call from the insurance company or a company hired by the insurance company saying you have an appointment with a doctor you don’t know. The person calling may have told you it was for a second opinion or an independent medical evaluation (IME). You might have just received a letter notifying you that an appointment had been scheduled with a different doctor. You probably have lots of questions about this appointment such as:.
- Do you have to go to the appointment?
- Do you have any say in which doctor the insurance chooses?
- Will the doctor be fair?
- Can you do anything if you do not like the doctor?
This article will attempt to help you understand what this medical examination is and what it means. The first important thing to understand is that this article is only discussing medical examinations where the insurance company decides on their own to get you an evaluation.
The rules are different when your doctor refers you for treatment with a different doctor. If you have been referred by your workers’ compensation authorized treating physician for treatment, then you should read our article discussing medical treatment after your work injury.
What limits are there on the insurance company’s rights to a second opinion?
Georgia workers’ compensation law does allow the insurance company to schedule evaluations for you with a doctor that they choose. The part of the law that allows them to schedule these evaluations is O.C.G.A. 34-9-202. The idea is that the insurance company should be able to get a “second opinion” about your medical treatment, as long as they agree to pay for it. However, the insurance company’s right to a second opinion does have limits.
- The appointment is just an examination; it is not treatment – the insurance company can pick the doctor to conduct the examination, but they cannot force you to change to this doctor for treatment (although they may try to use the report from the examination to get a judge to change your doctor)
- The insurance company has to prepay your mileage costs to the examination – the letter scheduling the examination should include a check paying you in advance for the costs of the mileage. The law requires this. Usually, you only get paid for mileage costs after the treatment has occurred, but this is different.
- The examination must be at a reasonable time and place – in other words, there are limits on how far the insurance company can make you travel. If there is a dispute about this, it will usually be decided by a workers’ compensation judge
- You can have another doctor attend the appointment with you, but you have to pay him or her – this right is not used much because it could be very expensive to hire a doctor to attend an appointment with you.
Many people are concerned about whether the doctor picked by the insurance company is going to conduct a fair and accurate examination. Our firm has certainly seem many reports from medical examinations scheduled by insurance companies that we did not believe were fair and accurate reports. If the medical report is not fair, it could hurt your case. As a result, you might not end up receiving the medical treatment you need.
What can I do if the insurance company doctor is not fair?
A good attorney specializing in Georgia workers’ compensation cases can usually help prevent this from happening. Even if you get a bad report from the doctor the insurance company picks, the attorney can help you arrange your own examination with a good doctor to get another opinion about your injuries.
If the insurance company denies the medical treatment you need based on a report from the doctor the insurance company picked, an attorney can request a hearing to get the medical treatment you need approved. If you would like to find out more about what is involved in hiring an attorney on your case, just click here to read one of our articles that will provide you some more helpful information.
Jason Perkins is an attorney who specializes in representing injured workers. He regularly publishes videos and write blog articles about Georgia’s workers compensation system and issues that are important to injured workers and their families.
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