Small group of IMEs paid up to $500,000 to deny claims and surgery

rude-doctor-ime

Peter Sharman’s blog Insult to Injury featured a disturbing article in which a small group of New Zealand doctors (IMEs) claimed to be receiving large payments in return for medical assessments that help the corporation (workcover) take costly long term injured workers off its books. We believe this article is well worth re-blogging over and over again!

Small group of IMEs paid up to $500,000 to deny claims and surgery

Whilst the following article refers to some dodgy IMEs in New Zealand, who is to say that the same is not happening in Australia?

60 Minutes, the ACC hatchet-men and Dr Vic Du Plessis’s 60 Minutes plea – let me stand up in court?

Posted on July 31, 2014 by Tasworkdoc

Originally posted on Lauda Finem on 14 September 2014

We have a post coming soon on this particular ACC Minister Judith Collins who yesterday according to Fairfax New Zealand:

……pledged to examine the independence of a small group of doctors claimed to be receiving large payments in return for medical assessments that help the corporation take costly long term claimants off its books.

In series of articles in recent years the Herald has reported concerns about a small group of doctors being used by the corporation to reject claims for elective surgery on grounds of pre-injury “degenerative” conditions.

However reports this week claimed the corporation was similarly using a select group of medical assessors who could be relied on to produce medical assessments of long term claimants that allowed the corporation to end their entitlements.

Yesterday, Green ACC spokesman Kevin Hague said he’d obtained data under the Official Information Act showing a small group of doctors were being paid up $500,000 which raised “huge doubts” about their independence.

Mr Hague named the four doctors under the protection of Parliamentary privilege as Martin Robb, Vic du Plessis, Bill Turner and David Beaumont.All four were identified as being paid somewhere between $300,000 and $500,000 last year. Dr Robb, Dr du Plessis, and Dr Beaumont saw 300 to 500 ACC claimants that year while Dr Turner saw 500 to 700.

“The enormous volume of work and the huge fees paid to (to these specialists)

He questioned Ms Collins in Parliament yesterday as to whether “an ordinary person would consider it possible that medical advisers like Dr du Plessis, Dr Turner, Dr Beaumont and Dr Robb could remain independent of ACC” when the corporation paid them so much.

“I think that is an issue that needs to be considered and I’ve spoken to ACC about it”, Ms Collins told him.

“The member will be aware that there is a new board now put in place. I will be meeting with the board and discussing obviously not the individual cases and matters but how we can end up with a system which obviously achieves good robust and independent medical reports and assessments that can be seen as independent by both the clients of ACC and ACC.”

However Ms Collins also indicated the issue as not a new one.

“In the year 2000 the same lawyers for ACC clients were claiming exactly the same issues around what they said were non-independent medical assessments. I don’t think much has changed but I’m happy to work with the member to get things to change.”

By Adam Bennet, New Zealand Herald | Email Adam

Well, we here at Lauda Finem would like to start with yet another small judgement, supplied by one of our readers, a fellow researcher and commentator; who uses the monika Vic.

It would seem that Dr Lodewicus (Vic) Du Plessis has previously had an opportunity to have his day in court. Not that it did him or his client any good (you guessed it another ACC styled insurance company) with the appellant court judge giving the “hard working” Doctors “professional opinions” a caning before awarding the victim of another of his so called specialist reports (yet another appellant) in excess of 115’000.00 Rand in compensation:

Dr Du Plessis has had at least one day in court already – A South African Court that is!

29. The medical experts agreed that the appellant suffered at least one epileptic seizure during the beginning of October 1991, but the cause thereof remained in dispute. Dr Zwonnikoff was quite confident on medical grounds that the appellant’s epilepsy arose as a result of the head injury, while he could find no evidence of a stroke which might have been the cause of the appellant’s weakness. Dr Du Plessis on the other hand could not confirm that the appellant had suffered a stroke, but he was convinced that the appellant’s hypertension, and not his head injury, was the real source of all his problems.

The respondent contended that there was documentary evidence forming part of the record which showed that the appellant suffered “a collapse” and a “syncopal episode” in May 1991. Dr Lengane certified that he examined the appellant on 6 May 1991. The nature of his illness was described as “hypertension – led to collapse”.

30. Dr Lengane referred the appellant to Dr Amanjee, a specialist physician, who recorded that he treated the appellant on 8 May 1991 for “hypertension” and a “syncopal episode”. Both doctors mentioned hypertension as a problem, but since neither of them testified at the trial it remained uncertain what the true nature of the appellant’s “collapse” or “syncopal episode” had been. Dr Du Plessis regarded the so-called collapse and syncopal episode as symptoms which were compatible with hypertension, but he did not describe either of them as a stroke.

The appellant underwent two brain scans, an ordinary Cat-scan and a Magnetic Resonance Imaging or MRI-scan. There was no evidence according to Dr Zwonnikoff of any form of stroke in either of the two scans done on the appellant. He was of the view that if the appellant had suffered a stroke severe enough to cause weakness the incidence of a positive scan was in excess of 90% on an MRI-scan.

31. Dr Du Plessis agreed that if one postulated multiple strokes they would more likely have shown on a scan than a concussive injury. The respondent relied on the evidence of Mrs Painter in support of its contention that the appellant’s brain damage was focal and that his disabilities were therefore probably a consequence of a stroke or strokes.

There was much debate as to whether the appellant’s brain damage was focal (which would be more consistent with a stroke) rather than diffuse (which would be more consistent with trauma). Both Dr Du Plessis and Dr Zwonnikoff expressed the view that the appellant’s brain damage was more diffuse. Mr Mallinson’s evidence was to the same effect.

Neither of the two Neuro-psychologists could however indicate with any measure of certainty whether the appellant’s problems were the result of one or more strokes or a traumatic head injury.

32. The court a quo accordingly found it impossible to decide on a balance of probabilities which of the
Neuro-psychologists’s theories was the correct one. I have the same difficulty in deciding this aspect of the case on the probabilities.

Dr Du Plessis gave the following evidence in chief:

“It must be borne in mind that a stroke can give you cognitive impairment just as much as a head injury can. So I have got no problem that there is cognitive and/or neurophysical problems that led to his laying off. My problem is that looking through the records that were made available to me it was my understanding of those records that the problem did not arise as a consequence of the head injury but as a consequence of the incident in October 1991.”

The learned trial judge then pointed out to him that there was evidence from the appellant’s fellow workers that when he came back to work after the collision he was not able to function as before, and Dr Du Plessis thereupon acknowledged that he was not aware of such evidence.

33. In the course of cross-examination Dr Du Plessis made the following significant concession in this connection:

“….if the weakness was there before this whole thing [the October 1991 incident] started and it was there after the accident, then obviously the weakness is related to the accident and I have never
denied that if there is evidence, that there is a weakness from
the day of the accident, that that must then be the cause. But the information that was available to me did not indicate that….”

Dr Du Plessis further conceded that if there was reliable evidence of a real change in performance by the appellant after the collision:

“then one must accept that something else – that the head injury must have been more severe than anticipated initially.”

I have indicated above that there was indeed credible and reliable evidence of Dr Keikelame, the appellant’s wife, Mr Duursema and other lay witnesses to the effect that the appellant not only complained of weakness shortly after the accident, but also displayed actual weakness and loss of memory.

34. Dr Du Plessis did not dispute that there were disabilities. He accepted that the appellant’s cognitive functions were impaired and that there was evidence of weakness when the appellant was examined by Dr Zwonnikoff and Dr Grobler in October and November 1991 and by Dr Keikelame in January 1992. Dr Du Plessis also accepted that there were reasons for Dr Grobler to board the appellant. He made these concessions despite the fact that he was not able to find a weakness when he examined the appellant in August and November 1993.

The evidence of the appellant’s weakness and his inability to cope with his work shortly after the collision no doubt lends support to his case that his disability was caused by the head injury sustained in the collision. The respondent’s expert, Dr Du Plessis, in effect conceded that such evidence would show that the weakness was related to the accident.

35. I therefore agree with counsel’s submission on behalf of the appellant that the temporal coincidence between the collision on the one hand and the onset of the appellant’s inability to cope with his work on the other hand created an inescapable probability of cause and effect.

In view of the aforegoing I am of the opinion that the appellant succeeded in proving that the head injury which he sustained in the collision was the most likely cause of his disabilities. It follows that the appellant has proved that the consequences of the head injury were a left-sided hemiparesis, epileptic seizures and cognitive and intellectual impairment.

Source: http://www.saflii.org/cgi-bin/disp.pl?file=za/cases/ZASCA/1997/93.html&query=doctor%20du%20plessis

Read the entire article on:

lauda-finem

Original source of this article: http://laudafinem.com/2012/09/14/60-minutes-the-acc-hatchet-man-and-dr-vic-du-plessiss-60-minutes-plea-let-me-stand-up-in-court/

We hope Lauda finem does not mind we copied most of their disturbing article – please visit their enlightening website!



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3 Responses to “Small group of IMEs paid up to $500,000 to deny claims and surgery”

  1. This doesn’t come as a surprise. Anyone who had to meet an IME knows that their reports are biased and it is not surprising either those IME are getting $$$$ here or overseas . That is exactly why we need a Royal Commission to investigate the practices of the workers compensations insurance and scrutise the earning of the so called IME the insurers use again and again, specially those working almost solely for the insurers after their come back from retirement.
    ROYAL COMMISSION is the answers then you can start again with a system where you have specialists being obligated to give back to the society and work for the state when selected randomly for a 3 months term during which that specialist will review medical case without patient’s name and with only a number. The Patient’s case assessment will see his file being assessed by 3 specialists and each specialist will be send the patient’s file under a different number to minimise collusion. There will be for the need to a central agency coordinating the 3 specialists panel selection and the sending of the patient;s file to each of the selected specialist, ensuring each patient’s file will be given a different number for each specialist to which it is sent!

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  2. Royal commission is the only way to go to expose all the rorts in the workers compensation industry, where insurers profits are put ahead of injured workers rights. However, no government will have the balls to do this as with the large volume of evidence available from injured workers and others experiences, the commission could well run for 3 years and cost an absolute fortune.
    There has been a royal commission into just about everything else, so why not a Workers Compensation Royal Commission, if society is in fact serious about protecting ALL persons human rights.

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  3. Alert! We have been made aware that at least one of the doctors featured on 60 minutes program has already visited Australia, used by a certain workcover insurance company, to, ah well, deal with long(er) term injured sods! Beware! If you are referred by your insurer to attend any of the featured IME’s, we strongly advise you to use the program’s evidence to request an appointment with a more independent doctor.

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    WorkcoverVictim August 8, 2014 at 8:02 pm