What To Do If You Are Asked To Take A Consultative Exam
When you apply for disability benefits, or when you are receiving benefits, the insurance company might ask you to see their own doctor for what is usually called a "Consultative Exam." This is particulary the case when they don't believe your medical record supports a strong case for disability and want to get a "direct look." Although some think that if the company wants to examine you it is preparing to deny your claim, this is not necessarily be the case. It could be just that your record doesn't provide sufficient information for the company to make a decision. A physical examination is one way to collect more information.
If asked, you likely have to take the exam. As a practical matter, even if you do not legally have to submit to an exam, you risk losing your benefit. A claims examiner can close your file for “lack of documentation” and “refusal to cooperate.”
However, it is not as certain that you have to see the insurer’s choice of doctor.
If your disability insurance company asks you to take a physical exam from one of their physicians, consider calling the Claims Examiner whose name and phone number should be on the letter announcing the exam. Ask if your own doctor can do the exam. Some companies may be willing to use your doctor and will even call him or her to review what they will pay and what type of exam they want. Others will insist that you see their doctor. If the insurance company says “no”, follow the protective guidelines in the next section of this article.
No matter which doctor you see, prepare for the appointment. To learn how, click here.
If a doctor refuses to let you record the exam and/or refuses to permit anyone else in the exam room with you,click here.