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