If a person is seriously injured in a Charlotte car accident, the person’s insurer – or the insurer of the at-fault driver – may wish to verify the extent of your injuries through the use of a compulsory medical examination before agreeing to a settlement.
It’s also sometimes referred to as an “independent medical examination,” though make no mistake – there is nothing “independent” about it. The reality is that the doctors who contract with the insurance companies to provide these services are paid handsomely – and they don’t want to lose those contracts.
This is not to say necessarily that the doctor will be dishonest. However, he or she is watching you very closely, and will be viewing your stated injuries with skepticism and in a light most favorable to the insurer. These doctors, paid by the insurer, will conduct a physical examination, review medical records, review deposition testimony and then write a report on their findings.
These findings are given a great deal of weight with the judge and jury, and physicians are known to be very adept when it comes to offering courtroom testimony. This does not mean you should be intimidated by the process, but it does mean you should be prepared.
The recent case of State Farm Mut. Auto. Ins. Co. v. Curran, reviewed by the Florida Supreme Court, dealt with the issue of compulsory medical exams in car accident cases.
Here, a woman was struck by an underinsured motorist in 2006. Later, she settled with the underinsured motorist’s insurance firm for the policy limit of $25,000. She then sought the collect on her underinsured motorist policy limit of $100,000. She contended that her actual damages were estimated to be at $3.5 million because of her post-accident diagnosis of reflex sympathetic dystrophy syndrome. Also called complex regional pain syndrome, this is a condition characterized by pain, tenderness and swelling of certain extremities.
Before her insurer would pay the $100,000 award, it ordered a compulsory medical examination, pursuant to the terms of the policy. The doctor to which they referred the plaintiff had 30 years of experience in testifying for insurance companies. Still, the policy was clear that the insurance company was under no obligation to pay the policy unless this condition was met.
The injured woman then made a few conditional requests with regard to the exam. Those requests went unanswered. Then the insurance company refused coverage, saying that she had breached the terms of the contract by refusing to undergo an exam.
She sued. The insurance company asserted an affirmative defense because the insured breached the contract. However, the trial court found that while the insurance company’s requirement was reasonable, so too were the requests of the insured, and she therefore did not breach the policy. She was awarded $4.6 million in damages, with her insurance company liable for the UIM policy limit of $100,000. The appellate court affirmed, holding that while the insured had breached the contract, the insurance company had to prove prejudice in order to avoid liability. It failed.
The insurance company challenged this verdict. The state supreme court again affirmed the ruling.
In cases where a doctor hired by an insurance firm issues a report based on a compulsory medical exam that is not in your favor, our experienced attorneys will work to point out any inaccuracies, inconsistencies and point out any indication that the report was skewed or unfair. This includes highlighting the relationship with the doctor to the insurance firm.
Contact the Charlotte injury lawyers at the Lee Law Offices by calling 800-887-1965.
State Farm Mut. Auto. Ins. Co. v. Curran, March 13, 2014, Florida Supreme Court
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In-Vehicle Infotainment & Risk of Distracted Driving Collisions in the Carolinas, March 3, 2014, Charlotte Car Accident Lawyer Blog