Front page of the Salem Statesman Journal, June 29, 2005.

Bill reforming workers' compensation medical exams advances

Workers' concerns about bias are valid, survey finds

STEVE LAW
Statesman Journal

They're called "independent medical examiners," but many say they should be called "insurance medical examiners."

When Oregonians suffer on-the-job injuries and file workers' compensation insurance claims, they get routed to doctors hired by the insurer to evaluate the injuries.

The system has spawned widespread complaints that the doctors are "hired guns" inclined to downplay worker injuries and keep compensation payments low. Even 53 percent of the doctors said the system is biased in a 2004 survey conducted by the state.

After years of agitating for reforms, injured worker Ernest Delmazzo won a key victory Monday, when the state Senate unanimously passed a bill to provide more safeguards in the system.

"The evidence is overwhelming that the IME system is corrupt," Delmazzo said. "People are paid to deny medical treatment. That's their job."

Senate Bill 311 would set complaint procedures so that injured-worker concerns can be addressed by state regulators and companies that hire the doctors. The state would keep a registry of doctors entitled to conduct the examinations. Companies would provide ongoing education about state laws and other policies, with the curriculum set by regulators.

State regulators also will consider penalties for doctors who fail to follow proper procedures.

"I think it's a good bill that's going to help all parties," said Dan Farrington, owner of Sunrise Medical Consultants, a Salem firm that hires IMEs throughout the state on behalf of workers' compensation insurers.

"Hopefully, this will clean things up and make them more honest, fair and balanced," said Sen. Vicki Walker, D-Eugene.

Sen. Gary George, R-Newberg, said he had heard too many stories of workers getting unfair treatment from the system.

"It is very important that the word independent be emphasized, and I hope that will be the outcome of this bill," he said. "We have not done an adequate job of representing the injured workers of Oregon, and it's time that we had some justice."

Delmazzo, an injured worker from West Linn who co-founded the Injured Worker Alliance, pushed a similar bill in the 2003 Legislature but got nowhere.

Then, the Management Labor Advisory Committee, the gatekeeper for all workers' compensation bills before the Legislature, asked the state to study the issue.

The resulting study left no doubt that the system was in need of reforms.

By surveying workers, attorneys, doctors and others involved in the system, researchers found many of the complaints about the system were valid.

"The system has become tainted from historical incidents as well as IME physicians who rely on insurer medical examinations as their entire income," researchers said in a summary of their work.

Among other findings:

• There are no professional or ethical standards for IME physicians, and no oversight of their work.
• There is no effective way for workers to complain, or for regulators to respond to those complaints.
• One-fifth of all injured workers were asked to drive more than 100 miles each way to visit the IME chosen by the workers' compensation carrier.

The survey also unearthed other alleged abuses, such as a buxom woman asked to disrobe for a doctor, although her injury was to her wrist.

One of the provisions of SB 311 permits workers to have a witness present at the examination.

Without that, "you're creating a huge intimidation factor," Delmazzo said. "The doctors hold their future in their hands and the doctors right now have no accountability. We believe that doctors who do bad things will be accountable."

Delmazzo hopes the bill might become a model for other sectors where IMEs are used, such as for automobile accidents.

Hasina Squires, a lobbyist for the IME firms, said the bill's prospects in the House are good.

"We think this represents a good compromise and a step forward," Squires said. "This is needed both from the industry's and the worker's perspective."

slaw@StatesmanJournal.com or (503) 399-6615