Can AI Write the Exam Report That Denies Your Claim?
If you are hurt and collecting no-fault benefits in Michigan, sooner or later the insurer may send you to a doctor of its own choosing for an examination. You sit with that doctor for a short visit, and weeks later a report appears saying you have recovered and your benefits should stop. What many injured people do not realize is that the report deciding their future may be drafted with the help of artificial intelligence, built from templates and software that lean toward the answer the insurer wants. This guide explains, in plain terms, what these insurer exams are in Michigan, how AI is creeping into the reports, and how you protect yourself when a computer-assisted opinion is used to cut you off.
What the Insurer’s Exam Really Is
Insurance companies call it an independent medical examination, but the name is misleading. The doctor is selected and paid by the insurer, not by you, and the exam exists to give the insurer a medical opinion it can use. Michigan law allows it. Under MCL 500.3151, when your mental or physical condition is material to a no-fault claim, the insurer can require you to submit to an examination by a physician. The exam has to be reasonable in its scope and conditions, but the basic right to ask for one is real. The opinion that comes out of it is frequently the document an insurer points to when it decides to terminate your benefits.
Because so much can turn on that single report, how it is produced matters. A careful, individual evaluation by a qualified physician who actually considers your history is one thing. A short visit followed by a templated, software-assembled report that reaches a predictable conclusion is something very different.
The Examiner Has To Be Qualified, and Many Are Not
The 2019 no-fault reform added real limits on who can perform these exams, and they are easy to overlook. Under MCL 500.3151, if your own treating doctor is a specialist, the insurer’s examining physician must practice in that same specialty. If your treating specialist is board certified, the examiner must be board certified in that same specialty. The examiner also must have spent most of the past year in active clinical practice or in teaching, rather than working full time as a professional witness for insurers. These rules protect you directly. If the insurer sends you to a general practitioner when your treating doctor is a board-certified orthopedic surgeon, or to a psychologist when the real question calls for a physician, the report may not comply with the statute, and a report that does not comply can be challenged.
How AI Is Working Its Way Into These Reports
AI does not replace the examining doctor, at least not openly. It sits behind the report. Some examiners and the companies that schedule them now use software that drafts narrative reports from a few inputs, pulls standard language about your diagnosis, and summarizes hundreds of pages of your records in seconds. A tool can scan your imaging or your file and generate findings the doctor then signs. Used well, that could save time. Used badly, it produces a report that sounds thorough but rests on a machine summary the doctor barely checked, with conclusions that drift toward whatever the insurer’s template favors.
The risks are specific. An AI summary of your medical records can miss the detail that explains your ongoing pain, or flatten a complicated history into a tidy story of recovery. Templated language can describe an exam in more detail than actually happened. And when a doctor leans on software to do the reading and the writing, the opinion may reflect the tool’s assumptions rather than a real judgment about you. The danger is not that a robot examined you. It is that a human signature gives an automated, insurer-friendly draft the weight of a medical opinion.
An Exam Report Does Not End Your Right to Care
One adverse report does not automatically end your benefits. Your right to reasonably necessary care related to the crash comes from MCL 500.3107 and turns on the medical evidence as a whole, not on the insurer’s chosen examiner alone. Your treating physicians, who have seen you over time, can carry significant weight. If the insurer stops paying based on the exam, that decision can be disputed, and the cutoff does not have to be the final word.
Two practical points protect you. Benefits that are not paid within 30 days of reasonable proof are overdue and draw 12 percent yearly interest under MCL 500.3142, and an unreasonable refusal or delay can shift attorney fees to the insurer under MCL 500.3148. Deadlines also matter, because the one-year notice and one-year-back rules in MCL 500.3145 can limit how far back you may recover. Acting promptly after a cutoff keeps your options open.
If the Report Becomes Courtroom Evidence, It Has To Be Reliable
When a dispute over benefits or a third-party injury claim reaches court, the insurer cannot simply hand the jury its examiner’s report as the truth. Expert opinions in Michigan must satisfy MRE 702, which the state strengthened effective May 1, 2024 to match the stricter federal standard. The party offering the opinion must show it is more likely than not that the opinion rests on sufficient facts and data, comes from reliable methods, and reflects a reliable application of those methods to your actual condition. The judge acts as a gatekeeper. If a report leaned on an unverified AI summary or a method the examiner cannot explain, your attorney can probe exactly how it was made, what software was used, what the doctor actually reviewed, and whether the opinion deserves any weight at all.
A Real Evaluation Versus a Software-Assisted Report
The table below shows the difference between a genuine medical evaluation and a report shaped by automation.
| Question | Software-assisted insurer report | Genuine treating evaluation |
|---|---|---|
| Who chose the doctor? | The insurer, which pays for the opinion. | You did, for your care. |
| How were your records read? | Often summarized by software in seconds. | Reviewed over time by a doctor who knows your history. |
| Where does the language come from? | Templates and AI-drafted narrative. | The physician’s own examination and judgment. |
| Can it be challenged in court? | Must survive an MRE 702 reliability test. | Grounded in firsthand, ongoing treatment. |
A polished report is not the same as a careful one, and that difference is what an experienced lawyer exposes.
What To Do When You Are Sent to an Insurer Exam
You have more control than you may think. Keep treating with your own doctors and follow their advice, because their records are your strongest evidence. Be honest and consistent about your symptoms, and do not exaggerate or minimize. Make note of how long the exam actually lasted and what the doctor did, since reports sometimes describe more than occurred. Keep every letter about the exam and any later decision to reduce or stop benefits. And if your benefits are cut based on the report, have the claim reviewed quickly, before the one-year-back clock narrows what you can recover.
Frequently Asked Questions
Do I have to attend the medical exam the insurer scheduled?
Michigan law lets an insurer require an exam under MCL 500.3151 when your condition is material to the claim, and the request must be reasonable. Refusing without good reason can create problems. The better approach is usually to attend, stay consistent, and have a lawyer help you respond to the report.
Is the exam doctor really independent?
The exam is often called independent, but the doctor is chosen and paid by the insurer to provide an opinion it can use. That does not make the opinion worthless, but it is one side of the story and can be outweighed by the doctors who actually treat you.
How would I even know if AI helped write the report?
You may not know from the report itself, which is part of the problem. Signs include record summaries that miss key details, templated language, or descriptions of an exam that seem longer than your actual visit. In a dispute, your attorney can ask how the report was produced and what software was involved.
Can one bad exam report end my benefits for good?
No. Your right to reasonably necessary care under MCL 500.3107 depends on the medical evidence as a whole. A cutoff based on a single insurer exam can be disputed, and your treating doctors’ records often carry significant weight against it.
What if my benefits already stopped because of the exam?
Act promptly. Overdue benefits carry 12 percent interest under MCL 500.3142, an unreasonable denial can shift attorney fees under MCL 500.3148, and the one-year-back rule in MCL 500.3145 limits how far back you can recover. A quick review protects what you are owed.
Does it cost anything to have a lawyer review the report?
No. A consultation with our office is free, and we work on contingency, which means no fee unless we recover for you. If an insurer exam was used to cut you off, it costs nothing to have your case reviewed.
Did an insurer exam report just cut off your benefits? Talk to a real attorney, free.
Attorney Manny Chahal will weigh that report against your treating doctors, demand to know how it was made, and fight to restore the care you are owed. Free statewide consultation. No fee unless we recover. Call 1-844-MCHAHAL.
Call 1-844-624-2425