The Evolution of Disability Policies
Part 4: Medical Examinations

In Part 4 of our series on how disability insurance policies have evolved, we’ll be taking a look at provisions related to medical examinations.

Older policies typically contain pretty basic and limited language regarding examinations. For example:

Physical Examination. The Company, at its own expense, may have the Insured examined as often as reasonably necessary in connection with a claim. This will be done by a physician of the Company’s choice.

Newer policies are much more expansive and typically list off a wide-range of examinations and testing that the company can employ. For example:

Independent Medical Examination. We have the right to require medical examinations, functional capacity evaluations and/or psychiatric examinations in the evaluation of what benefits, if any, are payable. The examinations may include x-rays, blood and urine tests, psychological tests, and other tests or procedures that We deem reasonable to evaluate whether You continue to meet the definition of Disability. The examinations will be performed by a doctor or specialist We deem appropriate for the condition and will be conducted at the time, place and frequency we reasonably require, while You claim to be Disabled. We reserve the right to choose the examiners. The examinations will be paid for by Us. Such examinations may include any related tests that are reasonably necessary to the performance of the examination. We may deny or suspend benefits under the Policy if You fail to attend an examination or fail to cooperate with the examiner.

(emphasis added).

Going to an in-person exam conducted by a doctor chosen by (and paid by) the insurance company can be intimidating and some testing can be painful and uncomfortable—both physically and emotionally. Whether a request for testing is proper depends on the underlying medical condition(s) and the particular terms of your policy, and it is important to approach this process in an informed manner.

Every claim is different, and these are just some examples of examination provisions taken from different policies. Your policy may contain different and/or additional language that could impact your particular situation.  If you are unsure about the terms of your policy, or how a provision applies to your specific situation, you should contact an experienced disability insurance attorney.

Search Our Site