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Independent Medical Exams: Insurance Companies Incentivize Deception

February 2, 2016

“Independent” Medical Exams?

I recently cross-examined a doctor — a U.S. Navy physician who was moonlighting for an auto insurance company — during an insurance arbitration. He had done a so-called “independent medical examination” on my client, who had a neck injury.

In his report to the insurance company and in his testimony to the arbitration panel, the doctor testified that my client had told him, at the end of the examination, that he was “just fine and could return to work” — a statement that the client, who had not yet returned to work, disputed.

Fortunately I had the examination recorded, and I was able to show that, at a minimum, the doctor shaded the truth. My client had actually said he could go back to work after his neck was “taken care of.” This was a bit of misrepresentation by the doctor, who continues to carry the water for the insurance company; unfortunately, this is not an uncommon tactic for physicians who administer “independent” medical examinations (IMEs) while on the payroll of insurance companies.

“Hatchet Job Tactics”

Attorney and blog author Steven Gursten writes about a similar experience on his blog at Michigan Auto Law. Drawing from a court cross-examination transcript, Mr. Gursten catalogues a litany of what he calls “hatchet job tactics” used by an IME doctor in the employ of an insurance company — including a report by the doctor that the client made statements during the exam that they had “been improving,” which was later contradicted by a recording of the actual IME appointment.

Sounds familiar, doesn’t it? Mr. Gursten documents a number of other questionable tactics used by IME doctors, including using non-standardized testing methods that can’t be verified and scored, misrepresenting the results of diagnostic testing, and ignoring medical facts that don’t seem favorable to the insurance company. As Gursten concludes: “You can’t make this stuff up.” (Although it sometimes seems that IME doctors can.)

At the same time, accident and injury victims who file insurance claims probably shouldn’t be surprised at the questionable results produced by IME doctors. While every physician should abide by their medical code of ethics and put the patient’s welfare first, the reality is that these physicians are hand-picked and paid by the insurance company to generally produce results favorable to their side during disputes over insurance claims.

What You Can Do

Although the law requires you to submit to an IME when asked to by the insurance company, this doesn’t mean you have to go into the process, which can be intimidating, unprepared. First and foremost, injury victims should consult with an attorney before undergoing an IME. Your attorney can provide you with information and guidance about what to expect from the IME doctor.

For example, IME doctors may look for a group of physical signs known as “Waddell’s signs,” which may indicate psychological components to pain or even a tendency within patients for exaggeration. As part of this process, the doctor may attempt to distract the patient to see if they produce different physical test results than when paying attention, or the doctor may have the patient perform movements that are based on, but not quite the same as, movements that are known to cause pain to see whether the patient reports pain when there shouldn’t be any. While there are legitimate medical and diagnostic reasons for performing these tests, the tests are, instead, often misapplied to discredit an injury victim rather than actually help them.

Although we don’t have reliable statistics about the impact of deceptive practices or biased results from so-called “independent medical exams,” there is no doubt that they can devastate accident and injury victims by producing inaccurate medical conclusions and causing victims to lose benefits unjustly. Knowing the facts about IMEs and what to expect during the exam process is the first step you can take to avoid getting blindsided by a process that often favors insurance companies at the expense of victims with legitimate claims.

Again, before you submit to an independent medical exam, you should always consult with an attorney. The Law Office of William D. Cook has the experience to guide you through this process so you can get the benefits you’re entitled to. Call our offices today at (907) 694-2000, or fill out a convenient online form to schedule your free consultation.

References:

Gursten, S. IME abuse? Read the transcript of Dr. Rosalind Griffin in a terrible truck accident case and decide for yourself. (2014, November 13). Michigan Auto Law. Retrieved from http://www.michiganautolaw.com/blog/2014/11/13/ime-abuse-dr-rosalind-griffin/

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