Independent Medical Examination – problems with radical, conservative & biased IMEs

biased-doctor

An independent medical examination also known as an IME is one of the most abused tools available to the workcover case manager in confirming the nature and extent of an injured worker’s injury and its compensability.

The IME can be used or abused to verify claim/injury compensability, to, ahh, confirm a diagnosis, to evaluate the appropriateness of the current medical treatment, to establish the need for future medical treatment (of course), and can also be used or abused to assess the amount of permanent impairment when the injured worker has reached maximum medical improvement.

Independent Medical Examination – problems with radical, conservative & biased IMEs

IME ‘s are the best way to check the injured worker’s diagnosis

According to our insider, a former workcover case manager, when the injured worker is allowed to choose their own medical treater(s) it is often very difficult to know if the extent of the injured worker’s injury is as severe as claimed, especially if the injured worker is being treated with an “injured-worker- friendly” doctor. OMIGOD! To be honest, I am (and know of quite a few others) quite fearful of one of my own treating specialists! And what about hard evidence such as x-ryas, CT scans, MRI’s? And, also would this mean that all our treaters would be lying (i.e surgeon, physio, GP, shrink?)

The same is true, says our informer,  if the injured worker has been sent to a doctor or specialist selected by the injured worker’s lawyer (for purposes of serious injury application etc).

And so it is that our case managers are of the belief that an IME is the best way to verify the accuracy of the diagnosis and the necessity of the injured worker’s current medical treatment plan. How interesting, especially considering they will routinely send us to an IME with no experience whatsoever in the field of our injuries! Rather they will send you to a general surgeon if you suffer from a complex orthopedic injury, or to an occupational physician when you suffer from a head injury.To properly select a doctor for an IME, the case manager really needs to know not only a doctor’s specialty (for example: orthopedics), but also the doctor’s sub-specialty (for example: knees). A copy of the doctor’s resume, certifications, lectures and publications can also be used to establish the doctor’s expertise in his sub-specialty. So, no excuse really!

The selection of the IME doctor should be undertaken with care

When the case manager determines there is a need for an IME again, the selection of the IME doctor should be actually undertaken with great care.

Most pathetic case managers fall into the trap of thinking ‘the injured worker has radical doctor who is over-treating and gives heaps of time off, or the injured worker is definitely malingering, therefore I have to use an IME doctor who is overly conservative and sends everybody back to work immediately preferably with no impairment rating.’

There are at least two problems with this way of thinking and using biased IMEs:

1. It really totally defeats the purpose of the IME – to be independent, to know the true extent of the  injury, to know the future medical treatment needed, and/or the actual level of permanent impairment, if its about a permanent impairment assessment.

2. The injured workers’ lawyers, defense lawyers and workcover (authority, commission etc) know the reputations of the doctors as well and will discount or outright reject any opinion from a doctor with known bias.
It is not the first time that known IMEs have been laughed out of Courts!

3. It costs them money, which is ultimately wasted.

Insurer’s Own Experience

It is well known that case managers (and insurers)  know from experience which IME doctors will perform an objective IME, and those who will not, and will select the IME doctor based on prior experience. Many insurers also have lists of certain IMEs! And they can always ask their defense counsel too, duh!

It is hard to believe insurers continue to send injured workers to known radical, conservative and biased IMEs. It plainly shows that they have no morals, no ethics, no standards and will do whatever it takes in an attempt to deny a benefit.

 

 



This post has been seen 4422 times.

3 Responses to “Independent Medical Examination – problems with radical, conservative & biased IMEs”

  1. Well said Workcovervictims! Every single word is spot on!

    All anyone wants is a fair go and an honest opinion/assessment so we can get on with our lives and live the best way we can depending on our injuries.

    The only reason the insurers like to spend so much money denying and stalling, is because IT DOES raise the cost of the system.

    As every WorkCover insurer get a percentage of the total cost of the scheme to “manage claims”- the more they spend, the more money they get!

    The insurers get bonuses for early return to work numbers and screw the long term injured to increase the cost of the scheme!

    The IMEs are such a large part of this bullshit practice!

    The bastards cannot lose!

    Thumb up 0 Thumb down 0

  2. IME Reports not in the insurer’s favour, that is if you are lucky enough to get an honest IME, there is every chance that the IMEs treatment suggestions will be ignored. If an IME is asked to write a supplementary report and suggests further treatment, perhaps more expensive treatment, there is every likelihood that the report will be withheld from you and your treaters – a direct breach of the Health Records Act (VIC).

    How many supplementary reports are voluntarily disclosed to injured workers ? ZERO. Ask for a list of all transactions on your claim number – it will show any payments made on your file – to you and any third parties. If you see the IME has been paid more than once, it’s for another report or several other reports.

    If you get a hold of the referral to the IME you would be amazed with the pre-amble that insurers give the IME and which reports they disclose and withhold. The referral covering letter “background info” can be very biased and in some cases contain loaded questions, a statement about the insurer’s goal, unfair and unfounded criticism of a treating doctor, etc. All in aid of “preparing” the IME. You have a right to these documents and should always ask for a list of all documents being released to IME. The insurer cannot refuse to supply you with the disclosures they make.

    Make sure your treating doctor(s) report is included and bring a copy with you to the appointment, in case they didn’t receive it. Also another unfair practice used by some insurers is not NEVER ask your treaters for reports so that there are less reports in your favour being disclosed to the IMEs. The insurer should be requesting reports from your treaters as a routine part of claims management and according to WorkSafe, the first step before deciding to set up an IME – but of course they do not want to pay for reports they already know they cannot use to terminate a claim!

    Thumb up 0 Thumb down 0

    Read between the lines December 4, 2013 at 2:38 pm
  3. I think one of the main problems is because the insurers’ legal branch allows their solicitors to choose the IME. They all know who will give a biased report and you are sent to the biased IME because their report will then be used to deny your claim.Once your claim is disputed you then have to go further and the matter becomes a legal one rather than a medical one and the further it goes the more work for the insurer’s solicitor who chose the IME, hence the matter goes on with the insurer’s solicitor getting paid more for each step and the preferred IME getting more work because their reports will cause a dispute and the cycle continues with financial benefits for these corrupt people at the cost of injured workers health. Its quite simply supply and demand in a symphony of well orchestrated corruption in my mind-and not by injured workers as they would like us to believe!

    Thumb up 0 Thumb down 0

    Complaint maker December 7, 2013 at 7:59 pm