Watch the full video at https://youtu.be/oytFzG6m2YI Chapter19659002wartWhen an applicant claims an injury that does not match the facts of the event that allegedly caused the injury, the adjuster will often be assisted by an independent medical examiner (IME) to verify the extent of the damage. IME is usually a forensic doctor or a chiropractor who has agreed to evaluate an injured person for a fee and is not involved in the treatment of the injured person.
In Pennsylvania, an insurance company that provides medical benefits to its insured after a car accident did not have to establish good cause before the insured was required to perform a physical examination administered by a physician at the choice of insurer, although the charter generally provided that the insurer want to force independent medical examination was obliged to show good cause. police gave the insurer the right to order an investigation without establishing a good cause. [ Fleming v. CNA Ins. Company 409 Pa. Super. 285, 597 A.2d 1
When an insurance adjuster testified that he was told by his supervisor at TOP that the purpose of a claims department was not to find ways to pay claims, but to find ways to deny claims. Thus, based on Dr. Ramey's report, he considered that there was sufficient information to deny the applicant's allegation, and that it was unnecessary to consider any other information.
The truth was the opposite of what the insurer testified about: the purpose of a claims department is to find ways to pay, not to deny, claims. The $ 5 million ruling that resulted in the Sprague case made insurance companies much more careful when ordering independent medical exams in California and hopefully will never again tell an IME what to end after doing the investigation.
© 2020 – Barry Zalma
Barry Zalma, Esq., CFE, now limits his practice to working as an insurance consultant specializing in insurance coverage, insurance claims handling, bad faith insurance and near-insurance fraud. insurers and policyholders. He also acts as an arbitrator or mediator for insurance-related disputes. He practiced law in California for more than 44 years as an insurance coverage and attorney-at-law attorney and more than 52 years in the insurance industry. He is available at http://www.zalma.com and email@example.com.
Mr. Zalma is the first recipient of the first annual Claims Magazine / ACE Legend Award.
For the past 52 years, Barry Zalma has devoted his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following libraries with books and other materials to enable insurance companies and their claims personnel to become insured.
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