Sometimes the way the questions are worded to an IME demonstrates the bias of the workcover insurer, writes an injured worker. Also certain doctors only do IMEs / or it may seem like it and those doctors seem to always have the same opinion. Injured workers talk to each other and they get an idea of whether a doctor is an “insurance” doctor or a proper clinician. In my opinion insurers who only use a narrow set of doctors for IMEs are setting themselves up for a battle…
The injured worker furthermore writes that using a doctor who is not on the routine list of IME doctors could help the insurer gain another viewpoint. Or better yet, ask the treating doctor for some ideas, if s/he gets some input into the IME process the workcover insurance companies may be less argumentative with the results.
Sometimes the insurer, because they are not doctors, choose the wrong specialty to perform the IME. For example a patient with a brain injury should see a neurosurgeon, not a general surgeon.
I know that some doctors seem to disagree with what ever the insurer wants but I believe they are in the minority. Some of the ethical, good, impartial IME’s knowledge appear not to be respected.
Independent medical examination – most reported problems
Below is a list of the most frequently reported issues and problems with independent medical examinations and IME doctors.
Very old IME doctors
Quite a few injured workers have reported being sent to old and very old IME doctors for an independent medical examination. Some of those very old IME doctors have been practicing medicine (incl. Orthopaedic surgery and Psychiatry) since 1955, which makes them around or over 80 years old, assuming they got their medical degrees at the tender age of 24-25 years.
How can we expect retired and, worse, octogenarian IME doctors who make about 100% of their living from workcover insurance paid independent medical examinations to write much, or anything really, that is contrary to what their paying client (the workcover insurer) is going to be happy with?
These are either retired or way-way past retired and or non-practitioning doctors, who hold themselves out as being experts where they have no expertise. For example the octogenarian orthopedic “surgeon” who has not done surgery since the mid-1980s, and is (often) unaware of new diagnostic procedures or modern surgical methods, yet holds himself out as an expert.
A couple of injured workers’ recent, shared experiences stand out.
One injured worker had complex shoulder surgery which involved the transplanting/grafting of the injured worker’s hamstring tendon(s) into his shoulder. Unfortunately the injured worker suffered from a permanent nerve lesion in his lower leg, damaged during the harvesting of the hamstring grafts (not an uncommon complication). The octogenarian IME (a ‘general surgeon’) did not understand the relationship between the leg (nerve) injury and the injured worker’s work-related shoulder injury, and repeatedly stated to the injured worker “… I simply do not understand the relationship between your injured leg and your shoulder ” … and “what is the relationship between your claimed (for) leg injury and your shoulder injury” Duh?
Another injured worker recently described that a very old IME psychiatrist still likes to uses electric shock treatment and still considers a lobotomy a valid treatment resource.
And another injured worker recently recalled an IME Psychiatrist repeatedly “falling asleep” during the examination.
Not only are the medico-legal reports generated by these octogenarian or non-practicing doctors biased towards the insurer (they are obviously enjoying the ‘perks’ of handsome $ rewards, perhaps for their monthly ship cruises?), but the content of these reports is, in many cases, actually truly frightening.
While most IME examinations reportedly last between 15 and 30 minutes, some injured workers have described their IME to be extremely brief. One injured worker, for example, said the IME doctor looked him over but never undertook a physical examination (as with his hands and/or instruments). The IME doctor simply reviewed the diagnosis of the injured worker’s treating doctor and told the injured worker he was “fine.” The entire process lasted 5 minutes.
Contempt for injured workers
Quite a few injured and ill workers have reported frank hostility from some IME doctors — and we’re talking about hostility and rudeness that simply appeared to be without any provocation. Many injured workers portray a system in which many presumes they are frauds until they are proven innocent.
One injured worker described hearing an other injured worker who was being seen by this IME doctor being badgered, with the doctor yelling “You’re not really sick!”; “You’re faking this!”. Other examples of similar contempt include the story of “B”, a 40 something tradesman who suffered 2 herniated discs (in his back) and arrived for his IME using a cane and having difficulty walking or sitting for long periods (more than 10 minutes). The first thing this injured worker was told by the IME is “You’re fine. When are you going back to work?”
Another injured worker with severe bilateral carpal tunnel syndrome (RSI) reported that when she first arrived for her IME, the IME doctor “seemed to have some sort of attitude” and, when she described her pain, he “just waved his hand, like, ‘So What?'”
Unavailable IME reports
Most injured workers we interact with have never seen their IME reports. As a result, those injured workers and their treating doctors have no opportunity to even review the insurance handpicked IME examinations, even those evaluation of the degree of permanent impairment.
Reports generated by the IME doctor become the basis for decisions made by the workcover insurer — decisions which in many cases are unilaterally implemented without consultation with the injured worker, let alone their treating doctors.
No witnesses allowed
Generally speaking, injured workers have no right to bring anyone to the IME exam (unless prior approval has been given by the IME doctor and the insurer), which effectively precludes witnesses to the IME. Psychiatric IMEs never allow a witness during the examination. Not even spouses are allowed to attend.
Several workers reported making an attempt to either tape-record their examinations or, at the very least, to bring a witness (i.e. support person) to observe the IME examination.
In many of these case hostile confrontation occurred. In one case, an injured worker brought her husband to the examination despite the protest of the IME doctor. In what appeared to the injured worker to be a retaliative action on the part of that IME, she was told by the IME doctor that, despite severe symptoms and clear diagnostic tests that confirmed the existence of a disabling injury, she was able to return to work “immediately” and, what’s worse, that she had no basis for a workers’ compensation claim!
Doctored IME reports
Several workers have (even recently) described and documented in great detail the altering of an IME doctor’s original IME report and/or notes/forms.
In one case, an injured worker experienced the altering of reports twice, by 2 different IME doctors, first in 2013 and again in 2014. In the latter instance, the injured worker, who had been struck by a 11o kg floor display while at work, was continuing to describe back pain so severe that the doctor’s IME report stated he recounted “difficulty doing simple activities such as washing dishes and washing his hair.”
The IME’s report, dated (date) 2013, concluded that “the prognosis for improvement is unfortunately extremely limited at this time.” Yet, in a letter to the insurance company dated 2014, the same IME doctor wrote (based on his initial 2013 report) “it is very difficult to assess the various factors present in Mr. X inability to return to the work”; and , hold on, that “the worker symptoms no longer appeared to be physical, but psychological” !
Another injured worker who has such a severe spinal injury that she is wheelchair bound reported that after she was examined by an IME doctor, two versions of the report about her condition surfaced under FOI. One was used to assert that her impairment was only a “moderate” — not a “severe”, enabling her to work part-time. The other report, signed by the same IME doctor, declared her to be totally disabled.
When this injured worker brought the discrepancy to the attention of her insurance company, the insurance company denied knowing about the “total disability” version of the IME report. When the injured worker (and her lawyer) pressured the insurance company for an explanation, they provided a letterhead document, signed by the IME doctor, stating that he altered the last page of the original report “after reviewing his notes and listening to his own dictation”. (He did not, however, alter the first 4 pages of the report, which document in great detail the injured worker’s total disability. ) The precise reasons for his changed assessment remain unclear to date.
No due process
Many injured workers feel there is lack of due process rights in relation to IMEs. Inured worker often report that – frequently – one-sided reports generated by IME doctors became the basis for decisions by the insurance company. These decisions unilaterally deny, cut off, decrease or delay weekly payments benefits and medical treatment— without consultation or even prior notice. Although IME reports and assessments can be appealed, some injured workers are intimidated by the prospect and accept decisions that are clearly, very inconsistent with the findings of their own treating doctor.
Unreasonable distance to travel to see the handpicked IME
In addition, many injured workers have repeatedly reported having to travel more than an hour for an independent medical examination, requiring either extensive use of public transport or very long drives. For an injured worker who is injured or sick, requirements to travel such distances become yet another barrier to pursuing their legitimate workcover claim.
A couple of recently shared IME experiences
When I first walked in the IME doctor’s office, he seemed to have some sort of attitude. I told him I was in pain, and he waved his hand, like So what?
He didn’t want to hear about my neck pain/injury. He said if I had the tendon in my wrist operated on that would take care of the pain in my neck. Then he examined me. He told me to put my head up and down. I told him I couldn’t, so he pushed my head for me. He did the same thing with my wrist and arms. I kept saying I was in pain, and he kept waving it away. He wrote down the angles of where he was pushing me on the chart, not what I was able to do on my own….
I had my leg hamstrings transplanted (grafted) in my shoulder as part of a reconstruction. Unfortunately I suffered permanent damage to my leg nerve during the harvesting of the hamstring(s). The insurance sent me to a very old IME orthopaedic surgeon to assess my leg injury. This 80 something year old IME kept telling me he “did not understand the relationship with my work shoulder injury and my subsequent leg injury. He kept saying he “never heard of such thing” (referring to a novel and uncommon procedure of using hamstring grafts in seriously damaged shoulders).
I asked the IME doctor if he’d read that I’d had a cortisone with anesthetic injection that very day, information that was on the prescription and my treating specialist doctor’s report I’d given him when I walked in the door. No, he had not. He also said that was not good, it would hinder/interfere his examination. I should have told him to stop right there …It didn’t. And, as he pulled this, pushed that, had me grip or move my wrist and hand, 2 minutes later he looked me straight in the eye and said “You don’t have carpal tunnel syndrome.” He never asked me about work. He wasn’t interested. He also wouldn’t listen to me when I told him I’d had an EMG, a scientific test which proved carpal tunnel syndrome….
…The doctor was hard of hearing, so I had to repeat myself a lot. I just don’t understand how he could perform surgery. He would ask me questions, but before I would answer, he would ask me the next question. I told him that every day I go to work, I hurt my shoulder more. The IME looked at my records and said: “They don’t have a real diagnosis here.” (despite MRI scans showing torn labrum and 2 rotator cuff tears). Then he manipulated my arms, and told me that I definitely had full range of motion and that there was nothing wrong with me…
…The [IME] doctor held my wrist and forearm in his hands. I stood up and he swung my arm back in a cavalier way, he was very rough with me, pushing me and making me wince from pain. Then he looked at my x-rays, and said, “you don’t have the thing you say you have.” I also heard the injured worker before me being badgered by the IME, yelling “You ‘re not really sick!”; “You’re faking this”. The IME doctor was very loud and obnoxious. I walked in and he was speaking into a Dictaphone and looked up at me, and said, “Bring that chair over there with you.” And I turned to get the chair and stopped and realised it was a test/trick. I couldn’t lift it anyway, so I dragged and kicked the chair with my leg. During the exam [ which lasted less than 10 minutes] the IME doctor would ask me a question and interrupt me, and then tell me to say it again into the Dictaphone — it seemed deliberate… Even though I already had my workcover case fully established, he said “he didn’t see anything wrong with me”.
Some thoughts about the IME process
Independent Medical Examination appear to be particularly harmful for injured/ill workers. We believe that the IME system is virtually unregulated and that it is often having damaging effects on the ability of injured/ill workers to receive fair and impartial treatment.
It is a system severely skewed in favour of insurance companies and while we have come up with a few ideas to improve the IME process in our earlier article titled “Improving the IME process – some thoughts“, we believe the workcover laws should be amended to reflect the above common issues and concerns.
- Call IMEs “Insurance Company Examinations”
IMEs are conducted by and for insurance companies and in no way function as truly independent examinations. They are often extremely biased but are given equal or greater weight than the comprehensive evaluation and examinations conducted by an injured worker’s treating doctor and specialist.
The workcover law should be amended to reflect the true nature of these so-called IME examinations.
- Exams should be held in locations that are not unreasonably far from the injured worker’s home address. All travel should be reimbursed.
- Each injured worker should automatically be supplied with a written copy of the IME report at same time it is sent to the insurance company; Each injured worker should automatically have the right to respond to the IME report — either themselves or through their treating doctor or even their lawyers — before a decision is made regarding their degree of impairment, their weekly payments benefits or payment of their medical expenses. The insurance carrier should not be allowed to unilaterally base decisions on IME reports without injured workers being given a chance to respond, or without consultation.
- When attending IMEs, injured workers should always be allowed to be accompanied by a witness/ support person of their choosing and should be free to audio or video-tape the examination.
- To avoid potential conflict of interest, IME doctors should be precluded from working for preferred workcover insurers/authorities and should also be providing primary, up-to-date care to patients. A cap should be set on the age of the IME!!!
- IME doctors who engage in the altering of IME reports should be subject to disciplinary action (ie. for fraud)
- Any other thoughts or suggestions?
People go to doctors, trusting them for help. You go there expecting them to take care of you. You should not expect anything unethical or unprofessional.
[Post dictated by WCV and manually inserted on WCV’s behalf]