Comments on: Why “Independent” Medical Exams Are NOT Independent

By: Jim Reed

Jim Reed — Thu, 03 Nov 2011 12:14:49 +0000

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
_____________________________________
Jim Reed, NY & PA Injury & Malpractice Lawyer
jreed@zifflaw.com

By: Anonymous

Anonymous — Thu, 03 Nov 2011 11:07:25 +0000

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.

By: Kini from N.y.

Kini from N.y. — Wed, 18 May 2011 03:59:54 +0000

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)

By: marty kunkler

marty kunkler — Sat, 07 May 2011 22:36:36 +0000

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

By: Jim Reed

Jim Reed — Thu, 04 Mar 2010 13:26:09 +0000

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

By: InjuredNurse

InjuredNurse — Thu, 04 Mar 2010 05:17:18 +0000

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)

By: Scott

Scott — Thu, 18 Sep 2008 21:32:37 +0000

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.

By: Mary

Mary — Fri, 12 Sep 2008 03:10:01 +0000

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

By: Rose

Rose — Fri, 25 Jul 2008 01:39:42 +0000

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!

By: Your Workers’ Comp. “Independent Medical Exam” | NY Malpractice Attorney | New York | PA

Thu, 12 Jun 2008 14:41:55 +0000

[...] The purpose of this post is to provide some general advice we give our clients prior to their IMEs. For more background on IMEs please read Attorney Jim Reed’s post “Why ‘Independent’ Medical Exams Are NOT Independent.” [...]