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Doctors, insurers take advantage of the New York State workers’ comp system

Workers injured on the job are usually examined by their own doctor first to determine the extent of their injury.  However, it isn’t uncommon for the insurance company responsible for paying out the workers’ comp claim to ask that the injured worker go to an “independent medical exam” (IME).

 

What many workers don’t realize is that this IME is paid for by the insurance company.  Insurers often use entities to book the appointment to give the appearance of impartiality, but the money for the exam originates with the very people contesting the claim.  This puts pressure on the doctor to return a report stating that the injured worker is able to work, even if this isn’t true.

 

Another issue is that entities are poorly regulated in New York, and these companies often book doctors they know will return a report favorable to the insurer.  In addition, entities aren’t required to employ staff members familiar with medical terminology, so the resulting reports – if prepared by the entity – can be erroneous.  While doctors are required to sign the final report, some admit to not reading what is produced by the entity.

 

All these missteps result in long case delays for workers and sometimes unfair and inaccurate conclusions about their injury or disability.  Without substantial reform to the medical exam side of the workers’ comp process, there is little hope for improving the reputation of the NY State workers’ comp program.

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