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Why are Doctors Forced to “Work Up Cases” and Order Expensive Diagnostic Tests?

December 17, 2009 by Steven M. Gursten

There are a lot of doctors “staring into the abyss” in Michigan, as philosopher Nietszche warned. These doctors see a patient who has been injured in an auto accident, and they must quickly order a battery of expensive medical tests to “work up” the patient. This is unfortunate and it increases medical costs.

But why is it happening?

Our auto accident attorneys know that the reason doctors jump to give crash victims diagnostic tests is mostly because of insurance companies in Michigan. These doctors are literally racing against the clock in efforts to protect their patients before the patients’ insurance companies stop paying for no-fault insurance benefits and the ability to truly help them passes.

Let me explain further.

Any experienced trauma doctor who sees car accident patients knows that, sure as clockwork, people will be cut-off by their own auto insurance companies usually within three to four months after a crash. Claims adjusters for many automobile insurance companies literally have a diary item on their computers that pops up after a few months (some after only a few weeks), to send victims to “cut-off” second opinion doctors who do one-time examinations for insurance companies. Known often as “independent” medical examiners (IMEs), these examiners are anything but independent. They make vast amounts of money from insurance companies and almost always find the accident victim no longer needs medical treatment and is able resume employment immediately.

Without an insurance company promising to pay for medical benefits, hospitals and nearly all doctors will refuse to see a patient to provide necessary care. What does this have to do with doctors rushing to order expensive diagnostic testing and sending injured people to specialists if they suspect something serious is happening?

Everything in the world…

These treating doctors, most of whom genuinely care about the welfare of their patients, send people out for a battery of tests and referrals to specialists, because they know or strongly suspect their patient is seriously injured. And they know in Michigan, they’re racing against the clock to document the injuries of their patients – before they are cut off by their own insurance companies.

The true cost of diagnostic testing

Critical diagnostic testing like an MRI or CT scan is also very expensive. But if someone has already seen an insurance “independent medical examiner” and been cut-off, there is almost no way to get an MRI covered. That means this person could have a severe disc injury or spinal cord injury that will go undiagnosed and untreated. Therefore, she will be unable to get the critical and necessary medical treatment she needs.

Sadly, if these insurance medical exams could just be postponed, say for at least six to eight months after an auto accident, most doctors could relax and treat accident victims more conservatively, which also means less expensively. But the game insurance companies have created forces many doctors to worry that if testing is not ordered immediately, severely injured car accident victims will never be able to receive it.

Again, without any bad faith law or punitive damages in Michigan to protect injured people, there is nothing to stop these insurance companies from sending their own injured customers to the most notorious cut-off IMEs within a few months of an accident.

Treating doctors know this, and are racing to protect their own patients. For example, if doctors submit an MRI showing a serious disc injury, the insurance company can no longer send the patient to a quick cut-off doctor to contend the injury is only a minor “whiplash” and therefore, it’s okay to return to work immediately and stop all payments for medical benefits.

The excruciating irony is that if the insurance company would wait to send auto accident victims to these cut-off doctors, the treating doctors could treat them more conservatively and the vast majority wouldn’t ever need expensive testing and referrals to specialists, because they would get better in say, the first eight months after the accident!

And the result, as any experienced auto accident attorney in Michigan will tell you, is simply heart-breaking. Completely innocent, good people call our attorneys and say they are in excruciating pain and cannot work, but their no-fault insurance benefits have already been cut off by their insurance companies. There is no wage loss to support their families, and there is no way for people to get the critical medical testing they need to find out what’s wrong; because no doctor or hospital will order expensive diagnostic testing or see them without a promise of payment.

The Real Tragedy – Cheating Insurance Companies Win

Unfortunately, lawyers cannot start a lawsuit to help every one of these people, because litigation can cost thousands of dollars, and many cannot afford to file one. If there is not significant money to support the lawyer filing the lawsuit — such as thousands of dollars in potential wage loss to at least set-off the cost of filing the lawsuit — then the attorney is working not only pro bono, but also volunteering thousands of his own dollars to support the car accident case.

The insurance company wins.

Even though our attorneys are only paid if they win the case, we have seen hundreds of people whose lives have been devastated because of these quick cut-off exams.

In the next few weeks, I will write three more blogs regarding abuse that arises in Michigan from “staring into the abyss” – everything from chiropractors gaming the system, to crooked attorney fees to outright lawyer fraud.

If your insurance company is giving you the run around, please call Michigan Auto Law for a free consultation at (248) 353-7575.

Steven M. Gursten is recognized as one of the nation’s top experts in serious car and truck accident injury cases and automobile insurance no-fault litigation. Steve has received the largest jury verdict for an automobile accident case in Michigan in four of the past seven years, including 2008, according to a published, year-end verdicts and settlements report.

– Photo by Creative Commons, by House of Sims

Related information:

Michigan No-Fault Law: The Basics

Dealing with Auto Insurance Companies

The “Set-off” Insurance Company Scam

Attorney Video: Do I Have a Case?

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One Reply to “Why are Doctors Forced to “Work Up Cases” and Order Expensive Diagnostic Tests?”

  1. An auto negligence claim against a driver who causes injury is also subject to dismissal without the objective proof of an injury that a diagnostice test can provide. An innocent victim with a real injury often has no recourse against those who caused his injuries, if his no-fault carrier has cut him off before he can get the proof required by a pro insurance interpretation of our law.

    Early cut-offs benefit insurance companies in many ways, some more subtle than others.

    By the way, isn’t it interesting that an injury victim requires objective evidence to establish an injury, but an insurance company can cut off benefits based on the totally subjective opinion of its hand-picked, paid examiner. Now, is that fair?

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