LLQP Accident & Sickness · Component 4.2 · 10% of the exam
The insurer requests an 'independent medical examination' (IME) during a DI claim. The claimant should be told:
- AThat the IME physician's opinion decides the claim on its own and cannot be challenged by the treating physician
- BThat IMEs are illegal, since a claimant cannot be compelled to see a physician chosen by the insurer
- That the policy entitles the insurer to examine at its expense, and refusal can suspend benefits
- DTo refuse the examination, since attending it would be taken as an admission that the claim is doubtful
Correct answer: C) That the policy entitles the insurer to examine at its expense, and refusal can suspend benefits
The right to examine is a standard provision. Cooperation is a condition of benefits.
Why the other options are wrong
- AThe IME is one input.
- BIMEs are contractual and lawful.
- DRefusal jeopardizes benefits.
Exam tip
IME: insurer's right, insurer's cost, claimant must cooperate.
Common mistake
Advising a claimant to skip an IME.
What this tests
CISRO competency component 4.2 — Provide customer service during the validity period of the coverage — which is weighted at 10% of the Accident & Sickness module. Written against the published curriculum.
More from component 4
- The agent's role in the claims process is to:
- A client with a non-cancellable DI policy stops paying premiums after a dispute with the insurer about a claim. The agent should warn that:
- When a client moves to another province, the agent should:
- A client asks to reduce the waiting period on his in-force disability policy. The agent should explain that the change:
- A client's disability policy lapsed six weeks ago for non-payment. The agent should:
- A client on claim asks whether she must keep paying premiums. The accurate answer depends on:
Practice the whole Accident & Sickness module
Timed sets weighted like the exam, and review of every question you miss. Free to start.