If you have been injured in an accident in NY or PA you will likely be subjected to what the insurance industry refers to as an “independent medical examination” (often called “IME’s” for short). As you will read below, IME’s are NOT “independent” in any sense of the word and they are regularly used by insurance companies to improperly deny benefits to deserving people. IME’s are another example of insurance companies at war with their own customers. Insurance companies love us when they are collecting our annual premiums and HATE us whenever we file a claim for those benefits we have been paying for for so many years….
The stated purpose for an IME is for the insurance company to have a so-called “independent”, supposedly unbiased doctor, offer an opinion on the severity of your injury, whether your injury was caused by the accident, and what will be the appropriate medical treatment of your injuries in the future. Sounds good in theory but the theory starts to break down from the moment the IME doctor is hired….
WHO BUTTERS YOUR BREAD?
An IME is conducted by a doctor hired by the insurance company, who is paid by the insurance company, and who reports to the insurance company.
As you might have guessed, the insurance companies who hire these doctors are looking for doctors who will tell them what they want to hear and any doctor who regularly tells the insurance company something they do not want to hear is quickly scratched off the IME list. The problem with this is that doctors have learned that performing IME exams can be VERY lucrative (how about earning more than $1,000,000 a year from IME’s alone?) so Dr’s are eager to remain in the good graces of the insurance companies who butter their bread…
THE BOOKS ARE COOKED
When Dr’s are recruited by the insurance companies, they learn in no uncertain terms what the insurance companies are looking for– MINIMIZE, MINIMIZE, MINIMIZE:
- Reports that say the person was NOT injured in the accident…. OR
- If injured, that the injury is NOT due to the accident but is due to a pre-existing condition…. OR
- If not due to a pre-existing condition, it’s really not so bad…. OR
- If it’s pretty bad, the injured person has fully recovered and needs no further medical treatment……
Not only are the doctors indoctrinated into what the insurance companies are looking for, they also are often only given the information that the insurance companies want them to have. I can’t tell you how many times over the years I have learned that the medical records for my client that were provided to the IME Dr were “missing” a few critical pages. “Ooopppsss, sorry we forgot to include the second MRI report for your client that demonstrated a herniated disk….We can’t figure out how that happened…” Give me a break!
THE IME SHAM EXPOSED BY RECENT CASES– IT’S ABOUT TIME….
Recent cases in NY have exposed the many ways in which insurance companies are manipulating their IME doctors to furnish reports favorable to the carrier and harmful to their injured customer.
As reported in this excellent post by N.Y.C. Attorney Eric Turkewitz, State Farm, one of the biggest car insurance carriers in New York, has been sued in federal court alleging that State Farm conspired to cook the books as discussed above. The most interesting thing about this case is that it is NOT being brough by an injured person who was victimized by a bad IME– the case is being brought by a DOCTOR. Here’s just a few key quotes from Eric’s post:
State Farm has been sued for racketeering in New York with a claim that it conspired with “Independent Medical Exam” companies and medical practitioners to produce fraudulent and sham medical reports.
State Farm acted in concert with “IME” companies and doctors to furnish fraudulent and boilerplate reports, according to the suit. The objective was to procure “scientifically dishonest reports in order to terminate benefits.”
Of particular interest is that the plaintiff is not an injured accident victim that was wrongfully deprived of insurance benefits, but John McGee, a physician practicing rehabilitative medicine. The physiatrist asserts that claims submitted to State Farm are being wrongfully denied, thus depriving him of the revenue he should be receiving for the treatment he rendered. He alleges that “sham” examinations were done by the defendants to procure false findings so as to cut off the benefits, resulting in the claims he submitted being denied.
NO SUCH THING AS “IME”….
Because I have learned that these exams are far from “independent”, I refuse to refer to these exams as “Independent Medical Exams”– let’s call them what they are:
- Insurance Medical Exams — Ooopppsss, can’t say the word “insurance” in the courtroom– I will post about WHY you can’t say the word “insurance” soon…
- Defense Medical Exams– That’s what I call them because that’s what they are– they aren’t independent, they are for the DEFENSE!
Thanks for reading,
Jim
_________________________________________
James B. Reed, Esq.
Personal Injury & Malpractice Attorney
Ziff, Weiermiller, Hayden & Mustico, LLP
303 William St., Elmira, NY 14902
Tel. (607) 733-8866 Fax. (607) 732-6062
Toll Free 1-800-943-3529
mailto:jreed@zifflaw.com http://www.zifflaw.com
James you say that “Not only are the doctors indoctrinated into what the insurance companies are looking for, they also are often only given the information that the insurance companies want them to have. ” What about all those plaintiffs who forget to tell the doctor about a prior accident or multiple accident or condition? Or what about plaintiff’s attorneys who send clients for exams to doctors “indoctrinated” by the plaintiffs bar, and don’t provide the examining doctor with the plaintiff’s complete medical history? If I had a dollar for every case where I saw that, in my days as an in-house defense attorney, I would be rich. I even once had a case where the plaintiff had two automobile accidents, a week apart, saw the same doctor (who happened to be a regular testifier and probably saw the plaintiff on a referral for treatment by the plaintiff’s attorney) for “treatment,” for the same complaints, and the second report made no mention of the prior accident and even went so far as saying that “prior medical history was unrelated.”
Your holier than thou, attitude is one of the problems with the plaintiffs’ bar which refuses to recognize the bad apples treating plaintiff’s today and instead embraces them. And don’t plaintiffs’ attorney send plaintiffs to doctors to get a report to help their case when the treating doctor won’t? In one case, it was I who called the treating doctor to testify about the plaintiff’s injuries, when the plaintiff called a notorious plaintiff’s doctor who just examined the plaintiff once and did not treat. Would you call that an “independent” exam?
Finally you say “Recent cases in NY have exposed the many ways in which insurance companies are manipulating their IME doctors to furnish reports favorable to the carrier and harmful to their injured customer.” I am sorry but what “cases” are you talking about. The only reference you make are to two lawsuits, which contain only the allegations of one side. Maybe they are accurate, but then again maybe they are not. Just because a plaintiff’s attorney says something in a complaint, does not, as far as I know, make it true. Let’s not jump the gun, but wait and see how the cases turn out before saying that the “allegations” “expose” anything. Remember, innocent until proven guilty, still applies on the civil side of the justice system, even if the burden is different. The plaintiff still has to prove his case.
Mr. Schepp:
Although I could have chosen to reject your comments, I posted them because you do raise a valid point that there’s always two sides to every story and that much of our perception is shaped by which side of the fence we are working. You say you were a defense lawyer and I have always been a plaintiffs’ lawyer so there is no surprise to me that our world views are completely different.
Where I do take significant issue with you is your claim that I have a “holier than thou” attitude. I have nothing of the sort nor would I accuse you of the same. My views are based upon my cold, hard experience representing injured people for more than 20 years. I have watched deserving folks getting screwed by the perversions of the system by insurance companies who care about nothing but their own bottom line– profit, profit, profit.
That is NOT to say that ALL insurance companies, all defense lawyers or all defense doctors are evil. To the contrary, I respect those who do the right thing, who fairly evaluate claims and who pay claims to deserving persons. I have no problem when claims are denied IF there is proof that a claim is improper. But what I cannot stand and will not tolerate, is when claims are routinely denied with no investigation because the carriers know that most people will just give up and not contest the denial. I cannot stand when the books are improperly cooked as I discussed in my post.
I will agree that there are examples of people “gaming” the system and I can tell you that I want nothing to do with those kinds of clients. In my area of Upstate NY, the vast majority of the people are good, hardworking people who just want the insurance benefits for which they have been paying lots of their hard-earned money.
I stand by every word of my post and I will be posting shortly about another NY case where the insurance company was caught red-handed telling their doctors to only report those parts of the exam that were favorable to the carrier. While I can at least acknowledge that there are some people who game the system as discussed in your post, do you honestly take the position that carriers do not try to manipulate their doctors to tell them what they want to hear?
Jim Reed
“Do you honestly take the position that carriers do not try to manipulate their doctors to tell them what they want to hear?” Yes. Claim adjusters don’t have the time and more often than not, because they don’t have the time, send the setting up, and report obtaining to outside venders. I am sure what you suggest must happen on occasion, but my experience with Liberty Mutual after 29 years (I am no longer with them, having been found to be costly to them) is that I have not seen it happen there.
P.S. See New York Personal Injury Law Blog: Allstate Sued under RICO for Alleged Sham Medical Exams: http://www.newyorkpersonalinju.....-over.html
For the other side of the story with regard to one of the “cases” that purports to support your theories.
And if you referenced future post is based upon the post from http://www.newyorkpersonalinjuryattorneyblog.com, I refer you to my comments there and those of some others who see this as a question of advocacy (not good in my opinion) style but not fraud or for that matter even unethical.
Mr. Schepp;
Again, thanks for your comments. For the record, my personal experience with your former employer Liberty Mutual is that they are one of the few consistently “good” carriers so it comes as no surprise to me that your personal experience at Liberty Mutual is very different from what I am routinely seeing out of the many “bad” carriers. I truly wish more of the carriers were like Liberty Mutual but sadly that is not the case…..
Jim Reed
I don’t doubt your experience, as I recall once trying to get an attorney to put more money on a case, to get it settled, by pointing out the large exposure his client had and his response, which indicated that he had forgotten who he represented. “What are you talking about, my exposure is only $100,000.” (His client’s coverage.)
I am a claims representative and have been for approximately 32 years, and I never heard of IME to benefit the claimant in any way. It is another form of bad faith policy
Mr. Williams:
What a breath of fresh air!! An experienced claim rep who confirms what any of us in the business know– IME’s serve one purpose and one purpose only– to screw people out of their insurance benefits.
Thanks for commenting and thanks for pulling back the curtain on the REAL purpose of these exams!
Jim Reed
I have worked for an IME company for 10 years, and I don’t believe that we were tring to screw anyone out of their insurance benefits. There are many claimants who are trying to claim that they have an injury, and when they are seen by a physician and the physician states that there is nothing wrong with this claimant, than that is what is written in his report, unfortunately because of the amounts of people trying to commit insurance fraud, it makes it harder for the person who has a legitimate claim and actually has injuries. But in the company that I worked for we never sent a negative report for anyone that was injured. So maybe there are IME companies out there that work for the insurance companies, but my company did not practice like that
To my surprise, my surgeon is refusing to write a prescription for hand therapy following endoscopic carpal tunnel release. However, the IME Dr. wrote his report in a vague fashion that I interpret to say that I actually should receive occupational therapy. Also, my surgeon insisted that I was ready to return to full duty work 4-weeks post surgery however the IME indicated that I would not be ready to return to unrestricted work for another month and a half. I found this refreshingly odd. But to add insult to injury, although I have already returned to work by the time the IME report came through, I brought it to the attention of the claims adjuster and expressed concern that by working on the PC prematurely, I may be impeding my recovery, and her response left me with my jaw hanging…….she said that it is my surgeon who determines when I return to work, not the IME……I wonder what her take would have been had the tables been reversed? I held back from asking her that question because I am saving that question for a later date. I simply asked her what the purpose of an IME is if his assessment isn’t taken into consideration??? I am awaiting for her email response. Should be VERY interesting.
I have been representing plaintiffs in automobile cases in Minnesota for almost thirty years. It is routine for the no-fault carriers to send insured’s for “independent” (i.e. adverse) exams after a month or two of treatment post-accident. I cannot recall an IME report on a soft tissue case in which the IME examiner concluded that my client needed any additional treatment. I have arbitrated at least 1500 of these no-fault cases, and won more than 90%. We are winning these cases even when we have a defense-oriented attorney as the arbitrator because, for the most part, the arbitrators are able to see the IME reports for the shams that they are. I am hoping that the 1st party bad faith bill just signed by our governor today will provide an effective tool to fight the IME industry’s corrupt practices.
Can IME’s be sued? After 2 IME’s following an auto accident I took my sister a lawyer on both occassions as a witness. The so called doctors do not even look at MRI’s nor do they do any actual exam. I was asked a few questions and thats it. After each “exam” I received letters saying I had nothing wrong with me and should return to work. My orthopedic MD on the other hand diagnosed my broken wrist and 3 herniated cervical discs following the accident and I was in a cast on the day of exams!! Its been 1 year and I am now cleared by my orthopedist to return to work (after months of physical therapy). I went to my employee health so called doctor and he tells me I am NOT FIT to work as a nurse and now I am fighting for my job. What a world full of crooks. I can be replaced by 3 new grads at the salary I am at so I can see thats why they don’t want me back. Yet 2 ins doctors while I am in a cast tell me to go back to work. All should be sued and hung. Whats your thoughts on this..Thanks
PS Still waiting for a dime from ins company for my monthly lost wages. I think the lawyer I hired is not so good….
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my husband had a severe shoulder injury, which resulted in shoulder separtion, torn rotator cuff, fluid build-up and entrapped ulnar nerve resulting in constant tingling, burning and pain in two fingers.He just went through an IME and we thought we were going for a second opinion. The doctors report was typical, no furthur treatment needed. He now lives with weakness, limited movement in shoulder and ulnar neuropathy. Doctor never looked at the MRI’s, he said “the facility that did them was not to be trusted”. Case closed. The only treatment he received was p.t. and a closed manipulation. Not one doctor has given him any options. What a racket!
BI have just read your Article,and was amazed that this is what My Fiance,and Myself are going through with Statefarm Insurance.We were in a Auto Accident,my car totaled {not our fault} and they are pulling everything to get rid of us.My Fiance is now going for his 3rd IME.I cant see how they can get away with this,When my Policy shows what I should be covered for.
They have booted me off, My IME The Doctor had someone elses information,when I told him I never seen these Doctors,He sorted through the papers,saw it wasent my name,then My info was “very slim”He said I have soft tissue,Definate problems lifting my left arm,BUT I can return to work and lift up to 20 pounds.{{I GUESS WITH 1 ARM?}My specicialist classified me as totally disabled, 3 discs in my neck,and 4 in my back. Im hoping My Attorney is persuing Arbitration.I am in so much pain,lost my job,and had no choice to go to Welfare.{Thank god I had insurance huh?}
Very Good Article, I hope something changes
I recently went through an IME for allstate only 2 months after a Tire off accident. After spending a total of 7 minutes in the room with me he came to the conclusion that I am able to return to work with no limitiations and need no further treatment or therapy and that my cervical strain is resolved. His report shows he recieved copies of my mri showing 2 herniated and 1 ruptured disc with compression of the spinal cord as well as an emg showing nerve infringement and disruption although he never mentioned these injuries any where else in his report. He also states in his report that I am 7 inches shorter than i really am 60lbs. heavier and have different hair and eye color than what I really do. Because of his report I recieve no lost wages and cannot afford my neccesary medical treatment. Allstate had been very un cooperative and I am currently waiting for arbitration (which my allstate rep was happy to tell me nobody ever wins). How can a doctor like this ever even get licensed? It’s medical neglect and malpractice. All I can say is be carefull take notes, and bring someone with you as a witness. I did this and now I am seeing what i can do to make sure this doctor can’t do this to anyone again.
What should you do if the IME doctor documents several assessment findings in his report that he did not assess…such as gait, heel walking, toe walking, straight leg raises, radial and pedal pulses, upper arm muscle tone and strength assessments… The physician also told me I had a “nerve injury that was permanent”, however, on the report for the insurance company he stated it was a “muscle injury” and I was capable of returning to full duty work NOW and lifting 100lbs repetitively. He told me I would need “a sedentary nursing position.” Also, while awaiting my appointment I overheard the physician on the phone asking for the form from “GENEX” that has “the exact questions on it…for this patient”…that they want him to answer. Any suggestions? The Defense Attorney has filed an application to stop my outstanding award (temporary total disability payments)
Very often we see a huge discrepancy between what is in an IME Dr’s report and what we know happened during the IME exam– claims that certain tests were performed that were NOT performed, claims that the patient reported history that they did NOT report (I once had a 73yo woman I represented who the IME Dr insisted that she reported a history of playing ice hockey– she had never been on skates in her life!), etc. The only effective way to combat the discrepancy between what REALLY occurred and what is in the report is to send a witness or a videographer to the IME exam to document the details of the exam. Many law offices send a nurse or trained investigator to IME exams with their clients. I know it’s too late to do that in your case but that is the most effective method. Second best is for you to sit down and analyze the IME report sentence-by-sentence to identify all inaccuracies and mis-statements. You then need to provide your summary to your attorney who will then have to figure out the best method to utilize your analysis. I wish you the best of luck!
Jim Reed
NY and PA Accident Lawyer
Outstanding article. I have a WC case on appeal. HO botched hearing. Carrier hired doctor who never examined me just issued a report on medical files carrier sent to doctor.
I have learned the best resource to stop all these doctors and carriers is file complaints with state medical boards. In Texas here, the other party so far that has treated me with respect is the state medical board. Also am filing bad faith suit vs. carrier. Wish I had known to record my state IME exam. That was a farce also but appeals court may remand case and I can do things much differently. Hell I filed complaints against hearing judge. Burying the state in paper work. Also I document well and verify everything now.
Thanks for the swell education.
marty
I found that most of the “documents” are pre-typed by the insurance comapies..I curretly went through a “medical scam..I mean exam”, and the dr never asked me more than 2 questions..the whole thing took less then mins…What caught my eye as I walked into the office, there were no pictures or paintings on the walls..everything looked bare..they were working off their laptops and cell phones..I thought Ashton Kutcher was gona jump out afterwards and say “You all got punk’d”! Which may have been funny..But no so, when the insurance company you’ve paid thousands and thousands of dollars to, does it..I’ve always known not to put trust in anyone, but when they force you to pay them then turn around and rob you a second time, it’s time to fight back..And I will!!! (legally of course)
I have been in the insurance industry for over fifteen years earning CPCU, CLU and ChFC as well as a Masters degree. Most of my time I was managing Property and Casualty claims. I spent three years in Personal Injury Protection in Michigan. I questioned the ethical behavior of the whole IME process. If we did not like a vague report from a physician, we simply did not use him/her again. The doctors who would support our preconceived notions were continually retained.
The “smoke” screen of “independence” was accomplished by using third party vendors such as MES, even though we selected the Doctors who we knew would give us the opinion we were seeking. We would bury the IME doctors with superfluous records and worse, we did not provide all of the records to the doctors. I am not sure it would have made a difference as a lot of the IME Doctors already had a template of their report. I noticed this when a “he” was referred to as a “she” consistently through the report.
During discovery, it is amazing how IME Doctors would say, “I don’t know how much I was paid by the the third party vendor for my IME’s” The third party vendor was the organization who confused how much was paid to each doctor as we paid the vendor as opposed to the Physician. If we paid the Physician, we could track it by using the Tax ID number.
As an example of the lucrative nature of IME Doctors, Dr. Leonard Sahn (Neurologist), records were subpoenaed and during discovery it was noted his average annual IME fees were $600,000 per year. Taking into consideration he did not have to pay liability insurance on the income and did not have to treat real patients, it is a really good deal for him. Dr. Mary Kneiser (PM&R), a well known IME Doctor, refused in Federal Court to tell how many times she testified because it would ruin her credibility. She testified over 300 times in State court and 99% of the time, the injured party was opined as no injuries by Dr. Kneiser. I guess the three who were positives for Doctor Kneiser were Quadriplegics.
I had faith in the insurance industry until I was in a serious accident and treated very badly because of my insurance background. I was rear ended at a high rate of speed and rendered unconscious, suffering spinal damage and a closed head injury. I went to an IME Neurosurgeon and was provided books on exercising my neck. The MRI showed major impingement from the disc on my spinal cord. The surgery revealed a large bone fragment in my cervical spine. I have been to more IMEs’ than anyone I know. The PIP IME’s stated I had a traumatic brain injury. The third party driver’s attorneys sent me to every specialty they could conjure up, less a Gynecologist.
As alluded earlier, fraud is a big problem and needs to be addressed. The real issue is when all injured people are treated with disdain as a nuisance or a fraud. I’m ashamed I was a part of this element of insurance. I joined insurance to help people.
You are not the first person from the insurance industry to express the very same sentiments to me that insurance has changed from a business designed to help their customers to a business that is at war with its own customers. Sadly, many defense medical doctors are an important weapon used by insurance carriers to deny legitimate medical claims by their own customers. It certainly is a sad state of affairs but thanks for your comments that help shed light on this brutal trend.
Jim
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Jim Reed, NY & PA Injury & Malpractice Lawyer
jreed@zifflaw.com