Filtering out fraudulent claims is an important task that insurance companies in the State of Michigan are required to do. Filtering out fraudulent claims has been the subject of a lot of jurisprudence in the State of Michigan.
With that, let us discuss some of the tools that are critical to filtering out fraudulent claims.
The Tools and Steps
Generally, the following are the steps that jurisprudence in Michigan allows as steps to take in the process of the investigation:
- Obtaining affidavits regarding proofs for coverage;
- Completing signed applications for benefits;
- Signing authorizations for the release of school, employment, medical records, etc.;
- Attending a mental and/or physical examination;
- Submitting to unrecorded and/or recorded interviews conducted by the carrier or its agents;
- Submitting to examinations under oath; and
- Insurers may also conduct surveillance to investigate the claim.
Let us discuss these tools.
Attending a mental and/or physical examination
Mental and physical examinations are always required by insurance claims. Generally, insurance companies need a physical examination to prove that there is indeed an injury and that the injury was brought about by the accident.
An Independent Medical Examination (IME) is required by law in Michigan. This specific provision can be found in Michigan Court Rule 2.311. It provides that when the mental or physical condition of a person is in controversies, such as after a car accident or slip and fall, the court may order the party “to submit to a physical or mental or blood examination by a physician or to produce for examination the person in the party’s custody or legal control.”
This is required when the subject matter of the case involves the physical condition or mental condition of the parties involved.
Under MCL 500.3151, if the physical or mental condition of a person is material to a claim for PIP benefits, the insurance company can request that the person seeking benefits submit to a mental or physical exam by physicians. Michigan law allows car insurance companies to vigorously defend no-fault PIP cases, using the reports made by the IME doctors as a sword to cut off or terminate benefits.
Who is allowed to perform the IME?
Not everyone can perform the IME. The doctors allowed to perform IMEs are under MCL 500.3151(2).
Generally, the following requirements must be complied with:
- It must be performed by a physician;
- The physician must be licensed in Michigan or another State in the United States; and
- The physician must specialize in providing care with the same board certification as the subject matter of the accident.
What does this mean? This means that the doctor must specialize in the subject matter that is the subject of the suit.
Additionally, under the same provision of Michigan law, it is required that the doctor who will be conducting the study must have spent more than 50% of his or her time either (1) actively treating patients in a clinical setting, or (2) teaching students in an accredited medical school or residency program. This active part is necessary to ensure that the individual doctor is well-versed in the subject matter.
In another part of this series, we will discuss more insurance claims and the requirement of the IME.
In Case of Doubt
In case of doubt, keep in mind that it is your no-fault insurance provider who would ultimately pay for your medical bills. As long as you get unlimited or no-limit coverage, you should be properly covered at a time when you need the best kind of coverage for your health and safety.
Contact Your Lawyer Today
If you have an insurance claim that you need assistance with, you should contact us today. A lawyer can help you get started with your claim. A lawyer at Haque Legal will see to it that your needs are met from the beginning to the end of the proceedings. You are always in good hands with Haque Legal and what it has to offer.
The article that you have read is based on general applications of the law. It is not legal advice and it is not to be construed as any legal consultation with the firm. No client-attorney relationship is created when you read the articles we have provided.
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If you are having trouble filing an insurance claim, call us immediately. If you have any problem with the law or are seeking justice and truth, our numbers are standing by to take your call.