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New Michigan IME rule: Insurance doctors must spend a majority of their time treating patients

August 24, 2010 by Steven M. Gursten

No-fault insurance lawyer breaks down the proposed independent medical exam rule 500.2252

This is the third post in my mini-series of blogs about independent medical examinations (IMEs) and how many notorious IME doctors make a great living claiming people with serious personal injuries are able to return to work and no longer need medical treatment. After all, there is little downside for them. The money is great, and in a state without many of the protections that exist in other states, insurance companies can select the nastiest “cut-off” doctors they can find to stop paying needed wage loss and medical bills to their own insured customers.

Perhaps finally realizing that Michigan auto insurers have been abusing the IME process, the Michigan Office of Financial and Insurance Regulation (OFIR) has proposed updated (although still very modest) IME rules to better protect Michigan residents from insurance company abuse.

The rules are currently under review by OFIR.

Proposed rule 500.2252 offers protection for auto accident victims from IME abuse

Under proposed rule 500.2252, an independent medical examiner must have either the same or a higher level of education, certification or board certification as the health professional treating an auto accident victim; AND an IME doctor must devote a MAJORITY of his or her professional time to treating patients.

From now on, these independent medical examiners would “have to prove that over half of their expertise is devoted to medical treatment.”

For example, in my recent trial cross-examination of Dr. John Baker‘s partner, Dr. Manfred Griffenstein, he testified he had not actually provided medical treatment to traumatic brain injury victims for more than a decade, yet an auto insurance company had paid him to evaluate my client’s TBI.

Therefore, I presume that both Dr. John Baker and his partner would have a lot of work to do if they want to maintain their IME practices. Same goes for many other notorious IMEs used throughout Michigan who make a fortune finding “nothing wrong” with seriously injured auto accident victims on behalf of automobile insurance companies and workers compensation carriers looking to improve their bottom line – despite the record-breaking profits insurance companies in Michigan continue to garner year after year.

Unfortunately, this is where it gets ugly. The Michigan Office of Financial and Insurance Regulation tabled the rule changes last December to allow for more comment and revision (Read: lobbying). As of now, the status quo still exists until OFIR presents the revised rule change. The OFIR tells us that state attorneys are moving forward with the rules, however, it could not give Michigan Auto Law a date as to when they should be finalized.

I don’t know what they are waiting for.

One last thought: I believe rule 500.2252(d) requiring actual clinical practice has the most teeth of all of the new standards. Plus, the case law interpreting the similar provision in the medical malpractice context may be quite helpful in using the new administrative rule to challenge questionable IMEs.

Steven Gursten is recognized as one of the nation’s top lawyers in serious car and truck accident injury cases and auto insurance no-fault litigation. Michigan Auto Law has received the largest reported jury verdict for a car accident case in Michigan in six of the past nine years, including 2009, according to published reports.

Related information about No-Fault insurance in Michigan:

Car insurance claims adjuster delays

Car accident settlements in Michigan – beware

Why the insurance industry in Michigan thinks we’re really dumb

Michigan Auto Law is the largest law firm exclusively handling auto accident cases and No-Fault insurance law throughout the entire state. We have helped countless personal injury victims recover all of the No-Fault insurance benefits they’re entitled to, and we can do the same for you. Call (248) 353-7575 for a free consultation with an insurance lawyer.

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