What is Doctor Shopping and How Can You Protect Yourself?

Doctor shopping is the practice of seeking out multiple doctors – often to either: (1) obtain a specific diagnosis or medication or (2) find one that agrees with you on your disability or illness.

Doctor shopping is not just a practice that some patients participate in, but also the insurance companies. In this article, we will go into depth about the practice of doctor shopping.

When we talk about doctor shopping, we are not talking about people who are looking for a second opinion on a diagnosis. We are talking about people who spend time finding doctors that agree with them on their diagnosis and often will prescribe them with the medications that they request. An example of this would be a person who thinks they have rheumatoid arthritis, but their primary care doctor says they do not. If this person continues to consult with multiple doctors until they get rheumatoid arthritis diagnosis, this would be considered doctor shopping.

Insurance companies will also shop for doctors. The goal of the insurance company is to save as much money as they can. They do this by finding doctors that will say that claimants are not disabled or not as severely disabled as they claim, such as through an independent medical examination (IME). If the insurance company is participating in doctor shopping, they will probably ask you to submit to more than one IME or obtain more than one “peer review” report. They can even request multiple IMEs and functional capacity evaluations.

When Does It Become Harassment?

Unfortunately, it is within the right of the insurance company to request multiple IMEs and FCEs until they get the answer that they want (which is usually to deny the claim.) There have been cases of claimants having to submit to 5 or more IMEs. However, the insurance company cannot harass you. If the insurance company is deliberately requesting multiple IMEs to scare or intimidate you, you need to gather your documents and consult an attorney.

I Was Injured During the Functional Capacity Evaluation. What Should I Do?

Many IME examiners will ask you to perform activities during the IME that you will not be able to do. They will push you to your absolute limit; this can lead to injury during the functional capacity evaluation. For this reason, you should:

1. Ask the insurance company to request a prescription permitting the FCE from your primary physician first. Although insurance companies know they are supposed to obtain a written prescription first, many do not, and without you knowing that they should, they are taking advantage of you;
2. Bring a family member or friend to support you and be your advocate during the exam. The IME examiner might say that they cannot stay due to privacy laws, but if you sign the consent, they can and should remain with you; and
3. Take before and after pictures. It is common to have some swelling after an IME. It might feel uncomfortable but taking photos of the part of your body that is injured before your exam and after to prove what the examiner did to you while you were in his or her care. Sometimes an examiner will say in the report that there was no swelling afterward, but if you have photos to prove it, you will be in a better position for a lawsuit.

Know the Credentials of Your Examiner

You have the right to know the credentials of the doctor who is going to perform your IME. Ask the insurance company to provide you with the doctor’s curriculum vitae. A curriculum vitae is similar to a resume but will include their life’s work. You are looking to see if this doctor has any experience in diagnosing and treating patients with the same condition as you, or if this is just a doctor the insurance company likes to use because they usually side with the insurance company despite having no real experience treating your condition.  

In Conclusion

Doctor shopping is a common practice in the insurance business as the insurance companies are looking for doctors that will make decisions during the IME that will be in favor of the insurance company. This can be a big challenge for claimants to overcome. By having a prescription from your doctor for the functional capacity evaluation, bringing a trusted friend with you, and photographing your injury before, and after the exam, you can help build your case if your claim is denied.

Using an experienced disability attorney will help you protect yourself against insurance investigators. Ortiz Law Firm is based in Florida but represents claimants across the country. Receive a free consultation by calling (866) 853-7703 with no obligation. We can help you evaluate your claim to determine if you will be able to apply for long term disability benefits and how to move forward with the process.