The Insurer Wants You to See Their Doctor. What an Insurer Examination Means for Your Accident Benefits
Published
After a car accident in Ontario, your insurer can ask you to attend an "insurer examination" (often called an IE, or IME) with a health professional it chooses. Many people only hear about it when the letter arrives. Here is what the letter must say, what happens if you do not go, and how to prepare.
Why the insurer asks for an examination
Under section 44 of the Statutory Accident Benefits Schedule, an insurer can ask for an examination when it needs to decide whether you are entitled to a benefit, or whether you still are, but not more often than is reasonably necessary. It is common when the insurer is considering denying or stopping a benefit, or deciding whether your injury is outside the Minor Injury Guideline.
The insurer cannot require an examination for treatment paid under the Minor Injury Guideline itself, or for death and funeral benefits. The insurer arranges the examination and pays for it.
What the insurer's notice must include
The notice must set out:
- the medical and any other reasons for the examination, in plain language;
- whether you need to attend in person;
- the name of the examiner, their health profession and any specialist designation;
- the date, time and place of each appointment.
If you need to attend in person, the notice must reach you at least five business days before the examination, unless you agree otherwise. The insurer must make reasonable efforts to book a day, time and place that suit you.
A list of the reports the insurer received is not a reason. If the notice does not explain why the examination is needed, ask the insurer in writing to clarify.
Received a notice and not sure what it means?
Send it to us for a free review →What happens if you do not attend
If the insurer sent a proper notice and you did not attend, you cannot apply to the Licence Appeal Tribunal about that benefit (section 55). The Tribunal can allow you to apply anyway, but that is its decision. Refusing because the notice looks incomplete is possible but risky. Get advice before you decide not to go.
How to prepare
- Read the notice and write down which benefit the examination is about.
- Bring photo ID, a list of your medications and the names of your treating providers.
- Describe your worst days as well as your good ones. Do not minimize symptoms out of politeness.
- If English is hard for you, ask the insurer about an interpreter before the appointment.
- Afterwards, write down how long the examination took and what was asked. Ask for a copy of the report.
Psychological examinations
If the examination is about anxiety, depression or post-traumatic stress after the crash, it can feel like you are being tested. Naira Velumyan trained as a psychotherapist before entering law and works with clients on what these assessments look at.
We read the insurer's notice with you, check that it gives proper reasons, and help you prepare for the appointment. Nothing to pay unless we win, and we work in English, Russian, Ukrainian and Armenian.
Frequently asked questions
Can I choose the doctor?
No. The insurer chooses the examiner. Your own treating providers can give their opinion in separate reports.
The report says I am fine. What now?
If the insurer denies or stops a benefit based on the report, you can dispute it at the Licence Appeal Tribunal, usually within two years of the denial. Read: Accident benefits denied? What to do next.
VIA Legal Services Professional Corporation. Naira Velumyan is a Licensed Paralegal in Ontario (LSO #P21370). This article is general information, not legal advice for your specific situation.
Naira Velumyan is a Licensed Paralegal in Ontario and the principal of VIA Legal. She holds a PhD in psychology and is a Registered Psychotherapist, which shapes how she handles psychological injury claims. Read more about Naira