Defense Medical Exams

In a personal injury lawsuit, the defense may ask for a medical examination of you by their a doctor of their own choosing. If you have personal injury protection (PIP) coverage that has been paying your medical expenses as a result of an auto crash, your PIP insurance company may also demand a medical examination. 

Purpose of Defense Medical Exams

A plaintiff in a personal injury lawsuit has the burden of showing the cost of claimed medical services was reasonable and those services were necessary to treat injuries caused by the defendant’s wrongful act or omission.  While PIP coverage applies regardless of who is at fault for the auto crash, the insurance company can stop payments if it decides the medical services are not reasonable, necessary and related to the accident.  The purpose of a defense medical examination is to help the defense or PIP insurer build their case that some or all of your treatment was not reasonable, necessary or related.

Inherent Bias

Defense medical examinations are typically a large if not exclusive part of the practice of the doctors and other medical providers that perform them. These doctors and providers are very well compensated for doing these examinations.  Unlike your treating medical providers, defense doctors are not examining you to help solve your problems or heal your injuries.  Insurance companies hire them to provide opinions that support a defense to or denial of your claim. Insurance companies are not likely to continue hiring doctors to do defense medical examinations who do not routinely provide such opinions.

Suggestions for Attending A Defense Medical Exam

The following suggestions are offered to help assure you are prepared for a defense medical examination.
  • Be aware that the exam may begin before the examiner actually starts examining you.  You may be observed when you get out of your car in the parking lot or walk into the office.
  • Be prepared to describe what happened to your body at the time of impact. The movement of your body helps connect the impact to the injuries you received from it.
  • Be prepared to talk with the examiner about the mechanics of the accident, your past and present symptoms, your medical treatment, any restrictions on your activities, and any prior or subsequent accidents involving the parts of your body that were injured in the incident giving rise to the exam.
  • Be concise when answering the examiner’s questions about your pain and symptoms. Don’t minimize your pain and symptoms, but also do not exaggerate them.
  • Be polite and cooperative at the exam. If the doctor asks that you perform any physical maneuver at the exam, do it to the best of your ability but within your limits.
  • Be honest in your reports concerning any pain of limitations you experience while being examined. The examiner is looking to find inconsistencies between your reports and what the examiner would expect as a result of the tests done at the examination to determine whether you are exaggerating or fabricating symptoms.