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Not-so-Independent Medical Exams for Workers Comp Claims

Injured workers in New York State may be familiar with this scenario.  The insurance company doesn’t believe you or your doctor when you say that you are too hurt to work.  They want you to go to in for an “independent” medical exam.  Seems reasonable enough, right?  Hold on.  What some workers don’t realize is that this “independent” medical exam is being paid for by the insurance company.  Sounds like a conflict of interest, doesn’t it?


This is the topic of the second article in a New York Times three-part series about the fraudulent and adversarial workers’ comp system in New York State.  The article opens with the story of a man being examined by an independent medical examiner in the NY workers’ comp program.  The man, a plumbing company driver, injured himself and was seeking workers’ comp because he did not feel able to work.  The doctor performing the “independent” medical exam (IME) appears to agree with him – and all this is caught on videotape.  However, the written report later issued with the doctor’s signature claims that the worker is fine and can return to work.  Is this kind of shocking about-face common?  Unfortunately what many legitimately injured workers find out is that it is not.


Not so independent doctors


One of the many hurdles that injured workers have to overcome in order to receive workers’ comp payments in New York is to undergo a medical exam by an “independent” doctor.  However, these independent examiners are paid by insurance companies – the very insurance companies looking for ways to save money on workers’ comp claims.  This conflict of interest means that sometimes workers with serious injuries that preclude them from working have their claims denied after being examined by one of these “independent” doctors.  If you are lucky, during trial the judge might overrule faulty IME findings, since some judges have noted that certain doctors just won’t find anyone disabled no matter how severe their injuries – but this isn’t always the case.  Even some doctors admit there is a problem.  The NYT article quotes one doctor as claiming that if he did an honest report about injures he saw, he’d be out of a job because “you have to give [the insurance company] what they want”.


Fighting fraud with fraud


IMEs are used in New York State in an effort to combat what is perceived as a problem with worker fraud.  Insurance companies often lament that workers and their doctors conspire to keep able-bodied workers out of work and receiving unnecessary workers’ comp payouts.  Despite the fact that fraud in the workers’ comp system most often involves employers, insurers came up with an answer: pay a supposedly independent doctor to confirm or deny the findings of the worker’s physician.  With over 100,000 IMEs conducted every year, these exams are big business for both doctors and something called an “entity”.


To preserve the illusion of neutrality, insurers often book exams through entities.  These are businesses set up to receive money from insurance companies, book doctor’s visits with a physician of their choosing, pay the doctor a fee for the exam, and prepare a report of the doctor’s findings.  Doctors are required to certify that they approve the written report of their findings, but in reality this doesn’t always happen.  In fact, the staff at entities who prepare doctor’s reports often don’t have any medical training; that, combined with physicians who rubber-stamp their reports leaves the door wide open for mistakes or even worse, fraud.  And in these situations it is the injured worker who suffers.


Help for injured workers fighting the system


Workers involved in the New York workers’ comp system may feel as though they have nobody on their side.  However there are attorneys like those at Markhoff & Mittman who have dedicated their careers to defending men and women injured on the job.  In fact, we even wrote a book about workers’ comp issues in New York State that you can have for free.  Don’t become a victim of what the NYT described as an unnecessarily adversarial system – contact us for your complimentary copy of “Five Deadly Sins that Can Derail Your New York Workers Compensation Case”.  You can also contact our office today to speak with one of our skilled NY workers compensation attorneys for no cost and no obligation.