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What does it take to cut off a “cut off” IME doctor?

November 19, 2013 by Steven M. Gursten

Federal RICO ruling, Jackson v. Sedgwick Claims Management Services, likely to shield No Fault ‘cut off’ IME doctors from RICO liability for savaging auto accident victims in their reports – a double standard favoring big insurers over people

IME cut off doctor

No one really knows just how bad and how crooked many of the IME doctors are that do these one-time insurance exams in Michigan and in many other states – until they have been sent to go see one.

And here I use the term “doctor” loosely, as many of these individuals forgot their Hippocratic Oaths long ago, as well as their integrity, as they cash in the easy insurance company money that comes from full waiting rooms of people waiting for their 15-minute exams so they too can be cut off.

What is an IME?

I’ve written about crooked insurance medical doctors (IMEs) many times in this legal blog. It’s common practice for insurance claims adjusters to send injured auto accident victims for so-called  “second opinion” exams by IME doctors. Yet far too many of these “independent” doctors are hand-picked and selected by insurance company adjusters who pick these doctors precisely so they can suspend and stop paying No Fault insurance benefits.

In short, they’re are paid a lot of money to find “nothing wrong” with seriously injured  and innocent people.

It is even worse on the third-party side. By “third-party,” I’m referring to the lawsuit side – the pain and suffering case against the at-fault driver (in reality, his or her insurance company hires the defense lawyer and pays the verdict).  In the third-party case, the injured individual is seeking money compensation for pain and suffering and for his or her injuries. Here there is a direct financial incentive to find the nastiest, most one-sided doctor that can be found to say absolutely nothing is wrong with someone.

This is because it is the defense lawyer who is picking the IME doctor. So we have the attorney who is picking the doctor. This attorney is charged with winning the case by mitigating as much as possible whatever compensation his client has to pay.

And now, thanks to a recent U.S. Court of Appeals for the 6th Circuit opinion, it looks like this dirty and dishonorable practice that diminishes the integrity of the entire civil justice system will continue for the foreseeable future.

Jackson v. Sedgwick Claims Management Services

In its recent opinion, Jackson v. Sedgwick Claims Management Services, the federal appeals court has most likely “cut off” all chances of holding “cut off” doctors and the insurance companies that deliberately us them accountable under the federal RICO Law (Racketeer Influenced and Corrupt Organizations Act ) for their schemes to hurt innocent people  by fraudulently denying No Fault insurance benefits. And often by making horrific charges of malingering and faking on the permanent public record (all based, of course, on a single 15- minute IME exam).

Although Jackson is a workers comp case, Jackson’s lesson will likely apply with equal force to  RICO lawsuits brought against “cut off” doctors used in third-party auto accident lawsuits and by insurance companies to deny PIP/No Fault insurance benefits.

In Jackson, workers who had been injured on the job accused their employer, their employer’s third-party benefit claims administrator and an alleged “cut off” doctor named Dr. Paul Drouillard of colluding in violation of RICO to discontinue their Michigan worker’s compensation benefits – despite abundant evidence demonstrating they were clearly and legitimately entitled to those benefits.

The Court of Appeals rejected the plaintiffs’ arguments and, in doing so, offered up the following statement:

“[R]acketeering activity leading to a loss or diminution of benefits the plaintiff expects to receive under a workers’ compensation scheme does not constitute an injury [that is compensable] under RICO.”

Crazy, right?

So, under the appellate court’s reasoning, racketeering (which, in the Jackson case, involved a scheme to use “false assertions” and “bad faith” to deny workers compensation benefits to genuinely injured workers) is permissible under the federal law that criminalizes racketeering (i.e., RICO), as long as the injury was not a RICO-approved injury.

Unfortunately, that’s the kind of injury the workers in Jackson suffered from … or so said the Court of Appeals.

Even though the injured workers in Jackson were being denied workers compensation benefits which they were rightfully entitled to, and this is the important part, which had been conferred on them by statute; the appellate judges ruled they couldn’t sue under RICO because their injuries were “personal,” not proprietary, in nature:

“In this case, the plaintiffs claim that they were legally entitled to receive certain benefits mandated by statute as a consequence of their personal injuries, and that they received less than they were entitled to under that system because of the defendants’ racketeering conduct. But the losses they allege are simply a shortcoming in the compensation they believed they were entitled to receive for a personal injury. They are not different from the losses the plaintiffs would experience if they had to bring a civil action to redress their personal injuries and did not obtain the compensation from that action they expected to receive.”

*    *    *

“Plaintiffs must allege a ‘proprietary type of damage’ to establish a RICO claim … and the plaintiffs in this case have only alleged that they received less from their personal injury claim than they believed they were entitled to receive.”

And here are some blogs our attorneys have written about notorious IMEs in Michigan:

Help, my auto insurance company is sending me to Dr. John Baker for an IME!

Dr. Mary Kneiser’s IME lawsuit

Tomorrow I will continue writing about RICO, specifically the double standard set forth in State Farm Mutual Automobile Insurance Company v. Physiomatrix. This double standard allows insurance companies to use RICO to attack doctors and lawyers, yet injured injured and innocent individuals cannot use RICO to stop insurance company abuse.

Related information:

Why insurance company medical exams are no laughing matter 

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3 Replies to “What does it take to cut off a “cut off” IME doctor?”

  1. I’m not sure it’s all one sided. I certainly agree that defendants have a nasty tendency to try and use retired surgeons or the like as examiners with the intention of them being hatchet men. On the other hand, I can think of many doctors – both treaters and examiners – beloved of plaintiff lawyers over here who are used precisely because they’re plaintiff-friendly and will assert (often in defiance of evidence) that a worker will be permanently unfit for all duties. Sadly, duelling experts seem to be an irreducible part of the system.

    1. Thank you for your comment, Stephen.

      Remember, there is an important protection already built into the legal system that prevents treating doctors who, as you write “will assert (often in defiance of evidence) that a worker will be permanently unfit for all duties.”

      Those protections are the evidentiary-based standards that a treating doctor or expert must meet, either under Daubert in Federal Court or under Michigan’s own similar evidentiary threshold contained in 500.2955 in state court. And I can tell you that defense lawyers love to bring these evidentiary challenges and motions (they get to bill for the motion and the hearing). Therefore, I would say that opinions without scientific foundation are often excluded.

      But there is a double standard because IME testimony does not have to meet this evidentiary threshold criteria.
      Far easier for an insurance company to hire an IME doctor who does a 5-minute physical exam, takes a 15-minute history, and then writes a report that the accident victim is fully recovered, can go back to work, needs no more medical care or treatment, and often that he or she is malingering and exaggerating symptoms to boot! Then the insurance company can cut off all of the injured person’s care and treatment and wage loss.

      Very little in the way of evidentiary standards or Daubert hearings when these IME doctors devastate people’s lives like this with the typical IME doctor exam and report.

  2. I was recently sent to Dr. Drouillard for an IME. I recognized heading into the exam that the esteemed doctor would shade his report after the appointment in the insurance company’s favor. I failed to accept the degree of the screwing of test results, treating doctor notes and physical therapy notes. And, he lied.

    A statement very early in the report stated that I “knew” that I was not going to benefit from doctor-patient confidentiality. This was never verbally discussed this. The office staff had me sign paperwork upon my arrival. I asked what the paperwork was as I did not have my reading glasses. I am now sure that the paperwork that I signed was agreeing to my lack of privacy.

    The doctor also did not address in the report that I stated that I have never hurt my left knee or hip and never had any problems prior to my injury at work. Nor did the doctor state that my physical therapist post surgery felt that my surgery was not 100% effective and I still had clinical signs of a partial torn ligament. However… the doctor did mention that I had been ill but my two COVID tests were negative.

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