IWA Testimony 12/14/04: IME Physician Bias Toward Insurers

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IWA Testimony 12/14/04: IME Physician Bias Toward Insurers

Postby Webmaster » February 25th, 2005, 7:00 pm

Testimony from Injured Workers’ Alliance to MLAC
Supporting documents were provided although not included here.

December 14, 2004

Management-Labor Advisory Committee
Labor and Industries Building
350 Winter Street NE
Salem, Oregon 97310

RE: IME Physician Bias Toward Insurers

Management-Labor Advisory Committee Members:

Oregon Workers’ Compensation Laws and Administrative Rules do not govern the conduct of those performing IMEs 1, yet when it comes to the worker, at the very moment they receive notice of an IME appointment, they’re intimidated with the warning that their benefits can be suspended if they fail to cooperate. The failure to cooperate is determined by the examiner.
An indication of the dubious reputation of IME’s can be found in the Medical Arbiter Resource 2, provided by WCD. Under the heading, “To avoid compromising the arbiter process, please:” it states, “Do not refer to your examination as an IME, insurer, or independent medical exam.”

The following is clear evidence that the current IME process is biased in favor of insurers and self-insured employers.

Exhibits A & B. Literature from a major IME facility 3 stated, “We do not believe there should be anything independent about an Independent Medical Evaluation.” The facility further promises a “Call from physicians after every exam or file review” This policy is also stated in Exhibit B.

Exhibit C. Another facility, Impartial Medical Opinions, Inc. says, “I.M.O. can help you with your case management by providing personalized service and experienced physicians that understand your business needs.”

Exhibit D. Yet another facility states, “Our quality Services team-nurses, paralegals, claims adjusters, and others experienced in claims issues-review all IME reports…” Why are paralegals and claims adjusters reviewing medical evaluations?

Exhibit E. The facility later states, “We select physicians who have experience working with claims professionals just like you. Performing IME’s is an acquired skill…” Since the major function of a doctor is that of diagnosing injury or illness, what are we to make of this statement?

Exhibit F. An IME practitioner in an evaluation report, among other things, stated that an injured worker had a full range of motion, full strength, and could perform a full squat-to-rise. Yet at the time the worker’s knee was wrapped in bandages from surgery and the worker was on crutches. An ALJ stated in his ruling that the examiner submitted a report of an examination and testified regarding that report yet no examination ever occurred.

Exhibit G. Another IME practitioner, in a deposition, admits that Oregon Medical Evaluation, Inc. has her signature stamp and that she did not write the first two paragraphs of a medical evaluation and that in fact the paragraphs were written by Oregon Medical Evaluation. She also states that she mislead in the independent psychiatric examination as she was neither a psychiatrist, medical doctor or physician.

Exhibit H. Here we have an examiner providing a medically stationary date to the day three months in advance.

Exhibit I. This is a replacement page, incidentally with the same date, of the above report where the medically stationary date has been removed by the examiner.

Exhibit J. This is an affidavit about an IME for a neck injury. It states that the exam took three hours and that the examiner caused great pain to the point where the examinee cried. In addition, the orthopedic performed a liver examination of the woman.

Exhibit K. In Robinson v. Nabisco, Inc. 4 (2000) cited below, the Oregon Supreme Court said the following: “During the examination, claimant complained of back pain. Watson directed claimant to raise her legs while lying on her back. Claimant stated that she could not raise her right leg. Watson then asked claimant to raise her left leg. When claimant raised her left leg, Watson moved it to a position beyond the point where claimant had moved it. Claimant felt immediate pain in the left low back and hip area. Medical tests indicated that Watson's maneuver had caused a new injury, specifically, a disc herniation on the left side. Doctors recommended surgical treatment for that injury.” The Court found that the examiner’s action created a compensable injury. The decision came 8 years and three months after the IME.
Cited below are other instances since 2003 where our highest Courts found compensable injury caused by an IME. 5

Exhibit L. Here we have two widely conflicting conclusions of the same exam. One asserts a “moderate disability” and work of four hours a day. The other, declared the worker to be “totally disabled.” The reports were prepared for Liberty Mutual Insurance, parent of Liberty Northwest.

Exhibit M. This is a IME report from James A. Coulter to an insurance company attorney. In it he states, “He [claimant’s attorney] made a dent in the current IME mill system particularly the cases seen at facilities such as MCN, Cascade and Western as constituting nothing but a pre-determined lynching of his client(s). It’s apparent that this practitioner, who only did IMEs at the time, had a dim view of his fellow IME examiners. Dr. Coulter then states, “The jury after I honestly described (no choice - I had seen the client at such a service)…” which clearly shows he has and does commit perjury. He also states they must carefully plan their counter-strategy. I also refer you to the paragraph starting at the bottom of page 3. The IME practitioner asks for more business, says he can deflect attacks on the current IME system in court, and concludes, “More cases are being tried and we must be one-up on the ways to win.”

Documents I’ve provided earlier to MLAC include communications between the Oregon Board of Medical Examiners and other agencies in which these following situations are discussed:
• Statements included in reports which did not occur during the examination;
• Canned reports (fill in the blanks) which may not even reflect correct gender, age, social history;
• A perceived insensitivity or lack of compassion for the claimants underlying medical problems;
• Rudeness to the individuals under evaluation;
• Complaints of significant discomfort during and following examination; and
• Failure to provide adequate explanation and/or adequate draping has led to allegations of sexual boundary violations.

Injured Workers' Alliance

Footnotes:

1 OAR 436-010-0270 (10) The person conducting the examination shall determine the conditions under which the examination will be conducted.
2 A word of caution, pg 9 - http://www.cbs.state.or.us/external/wcd ... arbres.pdf - 08/05/2002
3 Columbia Medical Consultants, Inc. closed its Oregon Independent Medical Examinations business operations effective December 31, 2003.
4 Exhibit K. Robinson v. Nabisco, Inc., 331 Or 178, 185, 11 P3d 1286 (2000)
5 McAleny v. SAIF, 191 Or App 105 (2003); Getz v. Wonder Bur, 183 Or App 494 rev den, 335 Or 104 (2002)
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