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Turning the Insurance Companies Doctor in to an Advocate for You

Posted by: Chad Hemmat | Friday, November 05, 2010 | 0 Comments | Back to Personal Injury Blog

Let's say it has been a year since you were rear ended by some texting driver. You have nearly a year of care, therapy, perhaps even a surgery. Now you are ready to talk settlement with the insurance company. After sending all of your medical records to the insurance adjuster, finally, after months, today you get a call from the adjuster. You would assume that at this point the discussion would be about the reasonable settlement value, right? Wrong! Instead she tells you that for her to "complete the evaluation" of your injury claim, she wants you to see a doctor of her choosing for a one-time examination.

One of the most powerful tools that insurance companies have at their disposal is sending you to the dreaded insurance company doctor. They call them "Independent Medical Examinations." But, rarely is there anything independent about the selection of these doctors. The reality is that the insurance company uses these doctor examinations to justify paying you less or even no money at all. The doctors selected to do these exams, not surprisingly, are generally predisposed to being on the side of the insurance company, not you. They know why you are there, and they know who is paying for you to be there. Rest assured, insurance adjusters select doctors they feel to be a "known quantity." For them, nothing would be worse than paying for you to see a doctor who ultimately supports your position over that of the insurance company's. Some insurance company doctors won't ever be swayed to say anything against the interests of the insurance company. However, if you follow the ten rules below, you stand a reasonable chance that at least part of the doctor's opinion will be in your favor.

Understand that no one should do this without help and research in advance. When the insurance company names certain doctors, the response needs to be swift and measured to reject a particular doctor if he/she is excessively unfair. This has to be done correctly, or you run the risk of being deemed "uncooperative" and that can mean no settlement. Attorneys trained in this specialty are necessary. However, the rules below assume that the doctor you are seeing is acceptable to your lawyer and while he/she may have a tendency to support the insurance company viewpoint more times than not, these rules will best assure that you will get as fair a shake as possible under the circumstances.

If you can turn the insurance company doctor into an advocate for you, the insurance company will lose all of its "mojo" and you will hold most of the cards in further settlement negotiations.

I have refined and taught these rules to my clients for nearly 20 years. The goal is to turn insurance company doctors to our side, or at least neutralize the sting of their medical opinions.

TEN RULES FOR TURNING THE INSURANCE DOCTOR INTO YOUR ADVOCATE:

1) Be respectful and polite to staff:

Seems basic, but rudeness and hostility is always going to be met with rudeness and hostility. Your first moment in the doctor's office should be the starting point of the respectful and polite new you. Be courteous, cooperative, and respectful. Pretend that this "Doc in a Box" you are being sent to is in fact a world-renowned specialist from the Mayo Clinic. Don't kiss up but make everyone in office know how pleasant and nice and respectful you can be.

Going to these exams can be demeaning. This is obviously not a doctor you chose to see, and the staff expects you to be rude and hostile. Most of the folks who show up to these appointments try their best to be difficult both with staff and the doctor. This is one of the first ways for you to stand out from the crowd. Don't be one of those hostile people. Be nice and polite.
By the way, if you think you can walk in and only turn on "nice" when you see the doctor, you are wrong. If you are a jerk to the receptionist, the doctor will hear about it. So be polite to EVERYONE in that clinic

2) Be early and compliant :

Arrive 15 and 25 minutes earlier than whatever instruction you get about your arrival time. Any earlier than that will make you look like a stalker. When you arrive, often staff will hand you a large questionnaire to complete upon your arrival. Smile politely, say thank you and quietly find a seat and fill it out. It often takes longer to complete the packet than the time the doctor's office plans. So arriving early will let you finish it without you having to struggle.

Sometimes, a doctor will mail you the questionnaire prior to your appointment. If this happens, complete it and then bring it by your attorney's office for a second look. On the day of your exam, still show up early, and give the completed questionnaire to the staff with a smile.

Again, the staff are used to hostility and rudeness, particularly in relation to the mass of paperwork the office is usually going to want from the one-time patient. But you are going to be the polar opposite: polite, cool, and most of all compliant. No fussing over the paperwork. Expect the paperwork and give the appearance of having no concern about completing it promptly.

3) Dress like you would for church :

Dress in looser fitting clothes and only slightly more casual than the rest of the world. Take a shower. No jeans, no collarless T-shirt. Often, you will be required to change into a gown for the examination. But the staff will see a respectfully dressed person entering their office and again you will stand out because of your pleasant apparance.

A few additional points: (1) Don't wear a suit and tie unless your appointment comes either before or after a job that requires you to wear a suit and tie; (2) Dress slacks or Dockers, long sleeve shirt with a collar, socks and shoes (not flip flops) are great; (3)Ladies, blouses and respectful conservative length skirts. And because you might end up in a backless hospital gown, PLEASE remember to wear reasonable underwear.

4) Treat the doctor like a real doctor:

Understand that doctors who do this kind of insurance company pandering are humans too. They expect to be treated with hostility, resentment and nastiness. But they will be surprised by you. You are going to treat them like a doctor.

Though many of these insurance company doctors have dubious credentials from second rate or even overseas medical schools, I recommend that without appearing to be kissing up, ask the doctor what he thinks is wrong with you. Ask him if he has any thoughts on how to help get you back on your feet. Many doctors will respond that because they are working for the insurance company they cannot comment. But regardless, they will appreciate your sincerity and respect you are showing them.

Other doctors will actually open up and begin an excellent doctor/patient dialogue, maybe even open up an anatomy book in their exam room and start showing you things. If that happens, start singing to yourself "To everything - turn, turn turn..." Because it is very likely at that point that this doctor will report back to the insurance company that you are the real deal and that your injuries are legitimate. That's right, their doctor has just been turned into your advocate.

5) Know that you are being watched:

The day you are scheduled to see the insurance company doctor is the one time that the insurance company will know for sure where you are going to be. Expect that surveillance will be taken of you on the same day as the insurance company doctor exam. Often on the day of an exam, you will see a strange van parked down the street from your house. And not surprisingly, that van will hang back but will follow you to your appointment. Expect that it will wait at your doctor's appointment and follow you home or to the grocery store or whatever.

I once had a client who limped into the doctor's office, but jogged out of the doctor's office and it was all captured on video. Not good. Assume that from your first appearance outside your house on the morning of the examination until your return to your home that evening that you are on surveillance video. Be sure to present physically to the doctor consistent with how you present to the rest of the world. If you don't have a limp, don't fake a limp for the insurance company doctor. It never works out and doctors are trained to spot a faker. You will not have problems if you simply be honest.

6) Don't exaggerate:

If you have never reported burning sharp pain down your leg before seeing the insurance company doctor, this would be a really bad day to suddenly report such a symptom.

These doctors will have studied your medical records either before you arrive for your appointment or at least before they write their report. Don't describe the car that hit you as going 70-80 mph when there is a police report (which the doctor will be provided as well) reporting that the car was going 30 mph. Don't report that while remaining in your seatbelt your head hit the front windshield and broke it. Seat belted people do not hit front windshields with their head.

All of these are exaggerations that the doctor is looking for and will undoubtedly report to the insurance company, at which point your credibility is shot. Tell the truth, and definitely do not exaggerate!

7) Give full effort:

Almost every examination is going to include range of motion testing by having you bend the same direction twice or more, using a measuring device. Understand that if you are holding back even a fraction on your true range of motion, this doctor is trained to be able to tell. He will report that you were giving less than full effort. That puts your extent of untruthfulness front and center. Rather, give full effort and avoid the issue entirely. Further, understand that many injuries exist without any range of motion loss. So don't worry if you are limber; it doesn't mean you aren't hurt.

I advise my clients to go in there and try to do 110% effort on everything. In fact, as you struggle to do your very best on every test, consider asking the doctor if you can try one of his range of motion test one more time because you are sure that with a second try you will have better results. Doctors eat this stuff up. The doctor will likely report how hard you were trying and that looks great.

8) Don't linger after exam. Leave but don't run:

Part of being polite is to not over-stay your welcome. As soon as the doctor tells you that you can put your pants on, put them on and respectfully and politely depart. Don't run, but leave on a high note. Don't ask the doctor "how did I do?".

9) Don't independently investigate or conduct reconnaissance / No stalking:

Some overzealous clients have tried to schedule an appointment with an insurance company doctor the week in advance of the one-time exam. The client figured that he might be able to charm the doctor or perhaps hoped to call into question the later exam.

The trouble is that it never works. These clinics are wise to this trick and it tends to creep out the doctor's office which makes it harder to turn the doctor to your side when the appointment actually occurs.

10) Maintain a positive attitude about the outcome of the exam:

Stay positive in this process. Understand that if you follow these 10 rules, even if the doctor ends up not completely on your side, there will probably be lots of things in the report that can help your objectives anyway. We call that neutralizing the sting of the report.

Also, even if this doctor writes a nasty report, understand that a good lawyer will point out how often they write similar negative comments on other insurance company reports. Stay positive and don't worry.

At Anderson, Hemmat & McQuinn, we believe that the key to success is preparation. That is why we take the time to prepare our clients for every step in their case. If you have questions about your claim and would like to speak with an attorney, please call us today.


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