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Personal Injury Protection (PIP) Mental and Physical Examinations

Can your insurance carrier choose a physician of their choice for your physical and/or mental examination when you have been involved in a Palm Beach County car accident?

The simple answer to this is MAYBE! BE CAREFUL because insurance carriers sometimes have abused the right granted under F.S. 627.736(7) to have the insured examined by a physician of their choice and have used this provision to stop paying claims. (Under F.S. 627.736(7)(a), the insurance carrier can only withdraw payment from a treating physician when the carrier has obtained a report from a physician licensed under the same chapter whose treatment authorization is sought to be withdrawn." However, the insurance carrier is not limited in this provision by the type of physician the insurance carrier may choose to perform an independent medical examination (IME) for other purposes. Therefore, an injured accident victim may not reasonably refuse to attend an IME (independent medical examination) on the grounds that the physician is licensed under a different chapter than the victim's treating physician. De Ferrari v. Government Employees Insurance Co., 613 So.2d 101 (Fla. 3d DCA 1993).

Does it make a difference that the medical examination be done by an agreed upon physician between your insurance provider and your Palm Beach County Attorney? The answer is only if the physician is questionable because the benefits of agreeing on a physician are uncertain. The reason is because there is no specified limit to the number of times a carrier can have an insured examined, presenting the incentive for the insurance carrier intent on denying benefits to continue its search for a desired opinion. As an accident victim in Palm Beach County, your refusal to attend subsequent examinations will no doubt cause the carrier to deny benefits anyway - a decision that will likely be upheld. See Allstate Insurance Co. v. Graham, 541 So.2d 160 (Fla. 2d DCA 1989); Griffin v. Stonewall Insurance Co., 346 So.2d 97 (Fla. 3d DCA 1977).

Simply put, if you are involved in a Palm Beach County car accident and as the insured unreasonably refuses an independent medical examination, the carrier "is no longer liable for subsequent personal injury protection benefits." F.S. 627.736(7)(b).

You do have the right to have a third party present at, and to videotape or record, your PIP examination. U.S. Security Insurance Co. v. Cimino, 754 So.2d 697 (Fla. 2000). Do not let the carrier frighten you into giving up your rights!