Do I Have to See the Insurance Company's Doctor After a Massachusetts Car Accident?

It depends on which claim the letter is attached to, and the difference is worth real money. If the examination belongs to a Massachusetts personal injury protection claim, a statute requires you to go: M.G.L. c. 90, sec. 34M provides that “The injured person shall submit to physical examinations by physicians selected by the insurer as often as may be reasonably required”, and the same paragraph makes “Noncooperation of an injured party” a defense to the insurer in any suit for those benefits. If a liability insurer is asking you to be examined while it evaluates your bodily injury claim and no lawsuit has been filed, no Massachusetts statute compels you to attend, and the pressure is the offer rather than a duty. Once a lawsuit is filed, the defense still cannot simply schedule you, because Mass. R. Civ. P. 35 requires a court order made “only on motion for good cause shown” that specifies “the time, place, manner, conditions, and scope of the examination”. Two things almost nobody is told: the examiner does not have to be a medical doctor, and does not have to practice in your treating provider’s field. One thing worth using: under M.G.L. c. 175, sec. 113J you or your attorney can demand a copy of the report. To talk through a letter you have already received, call Jim Glaser Law at (617) JIM-WINS. The line is answered 24 hours a day and the first telephone consultation is free.

The Letter Does Not Tell You Which Claim It Belongs To

A scheduling letter after a Massachusetts crash usually arrives on letterhead, names a date, a time, an address in a town you have no reason to visit, and a doctor you have never met. It rarely explains which of your claims it is attached to, and that is the single fact that determines whether skipping it costs you anything.

After an ordinary Massachusetts crash you generally have two claims running at the same time. One is the no-fault claim for personal injury protection benefits, which pays medical expenses and part of your lost wages as the bills come in, regardless of who caused the crash. The other is the bodily injury claim against the driver who caused it, which is where pain and suffering lives and which settles at the end. How those two run in parallel is set out in the article on personal injury protection in Massachusetts.

The examination duty in the Massachusetts General Laws attaches to the first claim, not the second. That is the whole architecture of this subject, and once you see it, most of the confusion goes away.

One caution before going further, because it trips people up. The distinction is not “my insurance company versus their insurance company.” Personal injury protection follows the vehicle, so a pedestrian struck by a car makes the no-fault claim against the striking vehicle’s insurer. That is exactly what happened in Brito v. Liberty Mut. Ins. Co., 44 Mass. App. Ct. 34 (1997), where a pedestrian claimed benefits from the insurer of the driver who hit her and the Appeals Court held that the insurer could require an examination first. The company writing to you may be the other driver’s carrier and still be your no-fault insurer. Ask which claim the request is for, in writing, before you decide anything.

The Examination That Is Actually Required

Here is the operative language from the third paragraph of M.G.L. c. 90, sec. 34M, in full:

The injured person shall submit to physical examinations by physicians selected by the insurer as often as may be reasonably required and shall do all things necessary to enable the insurer to obtain medical reports and other needed information to assist in determining the amounts due. Noncooperation of an injured party shall be a defense to the insurer in any suit for benefits authorized by this section and failure of an insurer to pay benefits in the event of such noncooperation shall not in any way affect the exemption from tort liability granted herein.

Three things in that passage do real work.

The duty is not unlimited. Examinations are required “as often as may be reasonably required”, and the purpose is stated: “to assist in determining the amounts due.” An insurer that wants a fourth examination in eight months on a straightforward soft tissue claim is operating outside the sentence it is relying on.

The duty is tied to a purpose an insurer must actually have. The Appeals Court in Brito read the statute as permitting the insurer, “where it has reason to doubt its liability, to require a medical examination by its own physician to assist in determining the ‘amounts due.’” The same opinion explains the practical reason the power exists: an insurer “is not required to pay unexplained medical bills merely on the unsubstantiated assertion by the claimant that they represent reasonable and necessary treatment for injuries caused by the accident.”

And the consequence for refusing is aimed at benefits, not at the rest of the case. Noncooperation is “a defense to the insurer in any suit for benefits authorized by this section.” The closing clause matters too, because it says that an insurer refusing to pay on noncooperation grounds does not lose the tort exemption the no-fault system creates. In plain terms, a fight about no-fault benefits does not reopen the parts of the system that were closed.

Answer Capsule

In Massachusetts, whether you must attend an insurance company’s medical examination after a car accident depends on which claim the request belongs to. For a personal injury protection claim, M.G.L. c. 90, sec. 34M requires that “The injured person shall submit to physical examinations by physicians selected by the insurer as often as may be reasonably required”, and provides that “Noncooperation of an injured party shall be a defense to the insurer in any suit for benefits authorized by this section.” For a bodily injury claim against the at-fault driver before suit is filed, no Massachusetts statute compels attendance. Once a lawsuit exists, Mass. R. Civ. P. 35 controls and an examination may be ordered “only on motion for good cause shown”, in an order specifying “the time, place, manner, conditions, and scope of the examination”. The examiner need not be a medical doctor, Ortiz v. Examworks, Inc., 470 Mass. 784 (2015), and need not practice in the same field as your treating provider, Boone v. Commerce Ins. Co., 451 Mass. 192 (2008). Under M.G.L. c. 175, sec. 113J you may demand a copy of the report, subject to a reciprocal obligation to furnish your own treating records. This is general information about Massachusetts law and not legal advice.

”Physician” Does Not Mean What You Assume

Most people picture a physician when they read a letter about a physical examination by a physician. The Supreme Judicial Court has held that the statute means something broader.

In Ortiz v. Examworks, Inc., 470 Mass. 784 (2015), a man injured in a Massachusetts crash claimed no-fault benefits. His insurer engaged an examination vendor, which twice wrote to him scheduling a “Physical Therapy Medical Evaluation” and identified the “Examining Physician” as a person holding a doctorate in physical therapy with an orthopedic clinical specialist credential. The examiner was a licensed physical therapist and not a licensed medical doctor. The injured person attended, then sued, arguing that the notice was deceptive because sec. 34M required a medical doctor.

The court disagreed on the underlying premise. It held that the word “physicians” in the third paragraph of sec. 34M “encompasses not only medical doctors licensed under G. L. c. 112, [sec.] 2, but also other appropriate licensed or registered health care practitioners, including physical therapists licensed under G. L. c. 112, [sec.] 23B.” The reasoning was practical: benefits are supposed to be paid quickly and cheaply, dental expenses are covered by the same benefit and cannot sensibly be evaluated by a medical doctor, and a rule requiring every examination to be done by an M.D. would slow the whole system down.

Two consequences follow for anyone holding a scheduling letter.

First, read the credentials rather than the job title. The letters in Ortiz accurately listed the examiner’s degrees, and the court held that describing him as the “Examining Physician” did not make the notice unfair or deceptive, though the court called it “somewhat confusing.” If you want to know what kind of clinician you are being sent to, the initials after the name are where the answer is.

Second, the examination itself is authorized conduct. Ortiz also brought a privacy claim, alleging that he had given up personal time, disclosed his medical history, and been physically touched without authority. The court rejected it, holding that because sec. 34M authorized the examination, the intrusions that came with it were justified. There is no separate lawsuit in a properly noticed no-fault examination.

The Examiner Does Not Have to Practice in Your Doctor’s Field

This is the finding that surprises people most, and it runs against the injured person.

In Boone v. Commerce Ins. Co., 451 Mass. 192 (2008), a pedestrian struck by a car treated with a chiropractor for injuries to his head, neck, shoulder and back, and the insurer paid the chiropractic bills for about eight months. The insurer then sent him to an examination by an orthopedic surgeon, who agreed the injuries were caused by the crash but concluded that continued treatment was unnecessary. The insurer stopped paying.

The injured person argued that the fourth paragraph of sec. 34M did not allow this, because that paragraph contains what the court called the same profession requirement. It reads:

no insurer shall refuse to pay a bill for medical services submitted by a practitioner registered or licensed under the provisions of chapter one hundred and twelve, if such refusal is based solely on a medical review of the bill or of the medical services underlying the bill, which review was requested or conducted by the insurer, unless the insurer has submitted, for medical review, such bill or claim to at least one practitioner registered or licensed under the same section of chapter one hundred and twelve as the practitioner who submitted the bill for medical services.

The Supreme Judicial Court held that the requirement did not reach the situation, and the hinge was one word. The protection applies where a refusal is based “solely” on “a medical review of the bill or of the medical services underlying the bill.” A medical review of that kind is a paper exercise: bills and records sent to a practitioner without a physical examination. The third paragraph, which authorizes physical examinations, has no same-specialty language in it, and the court declined to read one paragraph’s requirement into the other.

The practical rule that comes out of Boone is worth stating plainly, because it is the opposite of what most injured people assume. If your chiropractor’s bills are being paid and the insurer wants to stop, it can send you to an orthopedist and rely on that opinion. If instead the insurer never examines you and simply has a file reviewer read the paperwork, the reviewer has to hold the same kind of license your treating provider does. The physical examination is the insurer’s way around the same-profession rule, which is a large part of why examinations get scheduled at all.

What “Noncooperation” Actually Requires

The scheduling letter is often written to sound like a tripwire. Miss the appointment and the benefits end. The Massachusetts case law is less absolute than that, and it is worth knowing the difference before panic drives a decision.

The leading discussion is Boffoli v. Premier Ins. Co., 71 Mass. App. Ct. 212 (2008). The injured person there did not miss an examination; she returned a completed application for benefits about four months after the crash, and the insurer denied the claim for noncooperation. The Appeals Court reversed. On the cooperation question it stated the general rule directly: “As a general rule, breach of an insured’s duty to cooperate does not permit an insurer to disclaim coverage absent a showing of prejudice.” It then identified the narrow exception, which exists mainly to let insurers root out fraud: courts have recognized “a limited exception to the prejudice requirement in those cases where there was a wilful and unexcused refusal of the insured to comply with an insurer’s timely request for an examination under oath.” Because the conduct in front of it was not willful, the court held it was not noncooperation “under the insurance policy or the statute.”

The prejudice rule Boffoli was applying comes from Darcy v. Hartford Ins. Co., 407 Mass. 481 (1990), where the Supreme Judicial Court adopted it for cooperation clauses generally. Under existing law a breach of the duty to cooperate had to be “substantial and material” before an insurer could disclaim, and the court went further, holding that “actual prejudice to an insurer’s interests due to lack of an insured’s cooperation must be demonstrated before a denial of coverage will be permitted”. The same opinion rejected an insurer’s request for a presumption of prejudice, on the reasoning that forfeitures should follow proof of actual harm rather than possibility.

Two honest limits on all of that.

Boffoli concerned a late application, not a missed medical examination, and the recognized no-prejudice exception is written in terms of an examination under oath, which is a sworn proceeding conducted by the insurer’s lawyer rather than a medical appointment. Whether a deliberately and repeatedly ignored medical examination request falls inside that exception is not something any Massachusetts appellate decision we located has decided. Reading the general rule across to a missed medical examination is an inference from Boffoli and Darcy, not a holding.

And the inference cuts both ways. If a court did apply the general rule, an insurer would still be entitled to show prejudice, and an insurer that has been denied any chance to examine a claimant whose bills it is being asked to pay has a straightforward story about how it was harmed. Nothing here is a reason to skip an appointment. It is a reason not to treat one missed appointment as the end of a claim, and a reason to answer a noncooperation denial rather than accept it.

The reliable move is much simpler than any of this. If the date does not work, reschedule in writing and keep the copy. A written reschedule request is the single fact that turns a missed appointment from evidence of refusal into evidence of cooperation. The same instinct applies across an injury claim generally, which is the subject of what it means to mitigate damages in Massachusetts.

You Can Demand the Report, and They Can Demand Yours

Most injured people never see the report written about them, because nobody tells them they can ask. Massachusetts has a statute on exactly this point, and it is short enough to read in full. M.G.L. c. 175, sec. 113J provides:

Any company issuing or executing a motor vehicle liability policy or bond, both as defined in section thirty-four A of chapter ninety, which requests and makes a medical examination of a person injured in an accident involving a motor vehicle, shall, upon request of the injured party or his attorney, furnish said party or attorney with copies of reports of all medical examinations made by said insurer; provided, that such injured party shall, upon request of said insurer, furnish it with copies of reports of all medical examinations and treatment made by his attending physician or physicians.

Note what the section does and does not do. It is written in terms of any company issuing a motor vehicle liability policy that requests and makes a medical examination, so it is not limited to the company paying your no-fault benefits. It gives a right to “copies of reports of all medical examinations made by said insurer”, which is plural and covers the ones you were not told about as well as the one you attended. It requires a request; the report does not arrive on its own.

And it carries a condition. The proviso obliges the injured party, on the insurer’s request, to furnish copies of the reports of all examinations and treatment by their attending physicians. That exchange is usually a good trade for an injured person with a consistent treatment record, and a worse one for a record with unexplained gaps in it. It is not a reason to avoid asking. It is a reason to know what is in your own file first.

A report obtained early is also the thing that lets a treating physician answer it while the claim is still open, rather than a year later when the insurer’s number has already hardened. What insurers weigh when they set that number is covered in how much a Massachusetts car accident case is worth.

The At-Fault Driver’s Liability Insurer Is a Different Situation

If the request is attached to your bodily injury claim rather than to a no-fault claim, and no lawsuit has been filed, the picture changes.

The compulsion in the Massachusetts General Laws lives in sec. 34M, and that section is written in terms of assisting an insurer in determining the amounts due under it. There is no parallel provision requiring an injured person to be examined so that a liability insurer can evaluate pain and suffering. We checked this two ways. The examination duty appears in the text of sec. 34M itself and is expressly tied to that section’s benefits. And reading the section titles of the entire motor vehicle chapter and the entire insurance chapter turns up only two motor vehicle medical examination provisions: sec. 113J, which governs furnishing reports, and a section prohibiting medical examinations of applicants for a motor vehicle policy. Neither compels an injured person to attend anything.

What a liability insurer has instead is leverage, and it is real. It is evaluating a claim it cannot verify, and an unverifiable claim gets discounted. That is a negotiating problem to be managed with medical records, treating physician narratives and, where it makes sense, an agreed examination on terms your side helped set. It is not a legal obligation, and it should not be answered as though it were. How that relationship works from the first phone call is set out in dealing with an insurance adjuster in Massachusetts, and the same instinct that governs a recorded statement governs this: prepare before you participate, which is the subject of giving a recorded statement to an insurance company.

The same analysis applies with one twist to an uninsured or underinsured motorist claim. There the company evaluating your injuries is your own, under a policy you bought, and your policy contains a cooperation clause. That is a contractual duty rather than the statutory one in sec. 34M, and it is why a claim that looked like a routine benefits matter can turn adversarial. How those claims work is covered in uninsured and underinsured motorist coverage in Massachusetts.

Once Suit Is Filed, It Takes a Court Order

Filing a lawsuit does not hand the defense a standing appointment. It moves the question into Massachusetts Rule of Civil Procedure 35, which was last amended effective September 1, 2023. Rule 35(a) provides that where a party’s mental or physical condition is in controversy, the court in which the action is pending may order the party to submit to an examination “by a suitably licensed or certified examiner”, and then sets the conditions:

The order may be made only on motion for good cause shown and upon notice to the person to be examined and to all parties and shall specify the time, place, manner, conditions, and scope of the examination and the person or persons by whom it is to be made.

Everything protective about the rule is in that sentence. A motion has to be filed. Good cause has to be shown. The order, not the examiner’s office, sets the time, the place, the manner, the conditions, the scope and who performs it. Those are terms your lawyer argues about before you go anywhere.

Do not overread it. Good cause is not a high bar when the injury is the heart of the case. In Ashe v. Shawmut Woodworking & Supply, Inc., 489 Mass. 529 (2022), a man seriously injured in a work accident had been evaluated by his own neuropsychologist, and the defense moved for an examination by a board certified clinical neuropsychologist of its own to test those conclusions. The plaintiffs argued that a neuropsychologist was not a “physician” within the rule as it then read, and that good cause was missing. The Supreme Judicial Court affirmed the order on both points. On good cause, it noted that the motion judge, faced with a case in which cognitive deficits were the central issue, said she could not “imagine a better cause.” The 2023 amendment that followed replaced “physician” with “suitably licensed or certified examiner”, which settles the question for future cases in the same direction the court had already gone.

Rule 35(b) is the half worth planning around. On request, the party who caused the examination must deliver a detailed written report and findings, including test results, diagnoses and conclusions, and the court “may exclude from trial the testimony of an examiner who fails or refuses to make a report.” There is a trade attached: by requesting and obtaining that report, or by deposing the examiner, the party examined “waives any privilege available in that action or any other involving the same controversy” regarding testimony from every other person who has examined or may examine them about the same condition. And the whole subdivision “applies to examinations made by agreement of the parties, unless the agreement expressly provides otherwise”, which is a quiet warning about informal arrangements made by handshake.

What the Report Is Actually For

An examination report is rarely written to end your treatment. It is written to produce a date.

The most common form of an insurer’s medical examination report in a Massachusetts crash claim says that the injuries were caused by the accident, that the person has now reached a plateau, and that treatment after some particular date is no longer reasonable, necessary or related. That last clause is the product. Once it exists, three things move at once.

Payment stops going out. The insurer uses the report to decline bills for treatment after the stated date, which is exactly what happened in Boone.

Causation acquires a cutoff. Every symptom, every visit and every bill after that date is now contested rather than assumed, and any gap in your treatment record before that date becomes a talking point.

And the medical expense total, which is the number that governs the threshold, stops growing. Under M.G.L. c. 231, sec. 6D, a person injured in a Massachusetts motor vehicle crash may recover pain and suffering damages only if reasonable and necessary medical expenses are “determined to be in excess of two thousand dollars”, or the injury falls into one of the listed categories such as a fracture, a permanent and serious disfigurement, or loss of a body member. The statute counts expenses incurred, not expenses the insurer chose to pay, so a cutoff does not mechanically bar the claim. What it does is give the insurer an argument that the later expenses were not reasonable and necessary, and it removes the practical funding that keeps treatment going. In a claim sitting near the line, that is decisive. The threshold and its categories are worked through in the serious injury threshold in Massachusetts car accident cases.

That is the honest reason these appointments matter. A stranger’s opinion does not outrank your treating physician’s, and no adjuster believes it does. The report matters because it produces a date, and the date is what the rest of the file gets measured against.

When Benefits Stop After an Examination

A report is not a determination, and the statute that authorizes the examination also sets the schedule the insurer has to keep.

Benefits are “due and payable as loss accrues, upon receipt of reasonable proof of the fact and amount of expenses and loss incurred”. On notification of disability from a licensed physician, the insurer “shall commence medical payments within ten days or give written notice of its intent not to make such payments, specifying reasons for said nonpayment”. A denial that arrives with no reasons in it is not what the statute contemplates.

The enforcement mechanism sits in the same paragraph, and it is unusually favorable. Where benefits due and payable “remain unpaid for more than thirty days”, the unpaid party is treated as a party to a contract with the insurer and may sue in contract. On the unpaid party’s motion after the insurer answers, the District Court “shall” advance the action for a speedy trial. And if the unpaid party recovers a judgment for any amount due, “the court shall assess against the insurer in addition thereto costs and reasonable attorney’s fees.” The Supreme Judicial Court confirmed how strong that mechanism is in Barron Chiropractic & Rehabilitation, P.C. v. Norfolk & Dedham Group, 469 Mass. 800 (2014), holding that a party who had already sued could refuse the insurer’s later tender of the amounts owed, proceed to judgment, and recover its costs and fees.

Separately, how an insurer handles the whole episode is regulated. M.G.L. c. 176D, sec. 3(9) defines unfair claim settlement practices to include “Refusing to pay claims without conducting a reasonable investigation based upon all available information”, “Failing to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear”, and “Failing to provide promptly a reasonable explanation of the basis in the insurance policy in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement.” Conduct that violates those standards can be pursued through the consumer protection statute, which has a step that comes first: a written demand for relief, described in what a 93A demand letter is in Massachusetts.

What to Do When the Letter Arrives

Practical, in order, and none of it requires a lawyer to begin.

Find out which claim it belongs to, in writing. Ask whether the examination is being requested under M.G.L. c. 90, sec. 34M in connection with personal injury protection benefits, or in connection with a bodily injury claim. The answer changes what your options are.

Read the examiner’s credentials rather than the title. Ortiz is the reason the words “Examining Physician” tell you almost nothing on their own.

If the date does not work, reschedule in writing rather than skipping. Keep the email.

Bring your history straight. Know your prior injuries to the same body parts, your dates of treatment, and your current restrictions, because an examination that lasts fifteen minutes will still produce a report that describes your entire medical history. Inconsistencies between what you say and what the records show are the most reliably damaging thing that happens at these appointments.

Report symptoms accurately in both directions. Overstating is caught by the records, by surveillance and by your own social media, which is a bigger factor than most people expect and is covered in how social media affects a Massachusetts injury claim. Understating on a good day is just as costly, because a single “I’m fine” becomes the headline of the report.

Write down what happened afterward, the same day. How long the examination lasted, what was actually examined, what tests were performed, what you were asked. That note is what a report gets compared against later.

Request the report under sec. 113J, and expect to produce your treating records in return.

And keep the calendar in view while all of this proceeds. An examination dispute does not pause anything. The general deadline for a Massachusetts personal injury lawsuit is three years, set out in the Massachusetts personal injury statute of limitations, and a claim for no-fault benefits carries its own presentation requirement running from the accident date.

What This Article Cannot Tell You

Three honest limits.

Whether one missed appointment amounts to noncooperation under sec. 34M is not settled by any Massachusetts appellate decision we located. The general prejudice rule in Boffoli and Darcy points one way, the statute’s noncooperation sentence points the other, and the answer in a real case will depend on what the letters said, how many chances were given, and whether the failure to appear was willful. Treat the risk as real.

How often is “as often as may be reasonably required” is not a number. It is a judgment, made on the injury, the treatment course, and what has changed since the last examination.

And nothing here evaluates a specific report. Whether an examination report is answerable depends on what the examiner did, what records were provided, what was left out, and what your own physicians will say about it, none of which a general article can see.

If an Insurer Has Scheduled You for an Examination

The law here is not flattering in every direction, and it should not be dressed up. Massachusetts requires you to attend a no-fault examination. It lets the examiner be a physical therapist rather than a physician. It lets an orthopedist’s opinion end payments for chiropractic care. And it gives an insurer a lawful route around the same-profession protection that applies to paper reviews.

What Massachusetts also gives you is narrower and usable. A statutory right to the report. A deadline the insurer has to answer within, with a written explanation attached. A fee-shifting suit if benefits that are due sit unpaid past thirty days. A court order requirement, with terms you get to argue about, before any examination happens in litigation. And an unfair claim settlement standard that applies to the whole way a denial is handled.

Those tools work best before a report has been written, and they are much harder to use after an offer has been made and a file has been closed. Jim Glaser Law handles Massachusetts car accident claims, including claims where benefits have already been cut off after an insurer’s examination. There is no charge to be told honestly where a claim stands. The number is (617) JIM-WINS, the line is answered 24 hours a day, and the first telephone consultation is free.

Frequently Asked Questions

Q: Do I have to attend the insurance company’s medical examination in Massachusetts?

A: It depends on which claim the request belongs to. For a personal injury protection claim, yes: M.G.L. c. 90, sec. 34M provides that “The injured person shall submit to physical examinations by physicians selected by the insurer as often as may be reasonably required and shall do all things necessary to enable the insurer to obtain medical reports and other needed information to assist in determining the amounts due.” For a bodily injury claim against the at-fault driver before any lawsuit is filed, no Massachusetts statute compels attendance. Once a lawsuit is filed, the defense needs your agreement or a court order under Mass. R. Civ. P. 35.

Q: What happens if I miss the insurance company’s exam?

A: Less automatically than the scheduling letter implies, though it is still a bad idea. Section 34M provides that “Noncooperation of an injured party shall be a defense to the insurer in any suit for benefits authorized by this section.” But Massachusetts courts do not treat every lapse as noncooperation. In Boffoli v. Premier Ins. Co., 71 Mass. App. Ct. 212 (2008), the Appeals Court stated the general rule that “breach of an insured’s duty to cooperate does not permit an insurer to disclaim coverage absent a showing of prejudice”, and recognized a narrow exception without prejudice only for “a wilful and unexcused refusal of the insured to comply with an insurer’s timely request for an examination under oath.” No reported Massachusetts appellate decision we located holds that one missed medical appointment, standing alone, ends personal injury protection benefits. The safe course is not to test it: reschedule in writing rather than skip.

Q: Does the insurance company’s doctor have to be a real doctor?

A: Not a medical doctor, no. In Ortiz v. Examworks, Inc., 470 Mass. 784 (2015), the Supreme Judicial Court held that the word “physicians” in the third paragraph of M.G.L. c. 90, sec. 34M “encompasses not only medical doctors licensed under G. L. c. 112, sec. 2, but also other appropriate licensed or registered health care practitioners, including physical therapists licensed under G. L. c. 112, sec. 23B.” The examination in that case was performed by a licensed physical therapist whose notice letter described him as the “Examining Physician”, and the court held that the notice was not deceptive because it accurately listed his credentials.

Q: Can the insurer’s examiner be in a different specialty than my own doctor?

A: Yes. In Boone v. Commerce Ins. Co., 451 Mass. 192 (2008), a chiropractor treated the injured person and an orthopedic surgeon performed the insurer’s examination and concluded that continued treatment was unnecessary. The Supreme Judicial Court held that a personal injury protection insurer may refuse to pay bills based on a physical examination by a practitioner licensed in a different specialty from the treating or billing practitioner. The same-profession requirement in the fourth paragraph of sec. 34M applies only where a refusal is based “solely” on a paper review of the bill or the underlying services, not to a physical examination.

Q: Can I get a copy of the insurance company’s exam report?

A: Yes, on request, and this is the most useful thing in the statute book on this subject. M.G.L. c. 175, sec. 113J provides that a motor vehicle insurer “which requests and makes a medical examination of a person injured in an accident involving a motor vehicle, shall, upon request of the injured party or his attorney, furnish said party or attorney with copies of reports of all medical examinations made by said insurer”. The same sentence carries a condition running the other way: on the insurer’s request, the injured party must furnish copies of the reports of all examinations and treatment by their attending physicians.

Q: Can the at-fault driver’s insurance company make me see their doctor?

A: Not before a lawsuit is filed, if the request is attached to your bodily injury claim rather than to a personal injury protection claim. The duty to submit to an examination in the Massachusetts General Laws sits inside sec. 34M and is written in terms of assisting an insurer in determining the amounts due under that section. A liability insurer evaluating pain and suffering exposure has no statutory hook. What it has is the offer, and the practical fact that a claim it cannot evaluate is a claim it will discount.

Q: What happens once my case is in court?

A: Massachusetts Rule of Civil Procedure 35 takes over, and it is more protective than the pre-suit process. The rule provides that an order for examination “may be made only on motion for good cause shown and upon notice to the person to be examined and to all parties and shall specify the time, place, manner, conditions, and scope of the examination and the person or persons by whom it is to be made.” Good cause is not a high wall where the injury is the central issue in the case. In Ashe v. Shawmut Woodworking & Supply, Inc., 489 Mass. 529 (2022), the motion judge said she could not “imagine a better cause”, and the Supreme Judicial Court affirmed.

Q: The exam report says I do not need more treatment and my benefits stopped. What now?

A: The report is one physician’s opinion, not a determination. Section 34M requires that benefits be paid “as loss accrues, upon receipt of reasonable proof of the fact and amount of expenses and loss incurred”, and that on notification of disability from a licensed physician the insurer “shall commence medical payments within ten days or give written notice of its intent not to make such payments, specifying reasons for said nonpayment”. If benefits that are due remain unpaid for more than thirty days, the same section gives the unpaid party a right to sue in contract, directs the court to advance the case for a speedy trial on motion, and provides that a party who recovers a judgment is awarded “costs and reasonable attorney’s fees”.

Q: Is Jimmy Knows AI giving me legal advice?

A: No. This is general information about Massachusetts law, not legal advice, and reading it does not create an attorney-client relationship. Whether a particular examination request is proper, and what a particular report is worth, depends on facts a general article cannot see. To discuss a specific situation, call Jim Glaser Law at (617) JIM-WINS. The line is answered 24 hours a day. The first telephone consultation is free.