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How to stop independent medical examination abuse and fraud

November 7, 2017 by Steven M. Gursten

Insurance companies’ independent medical examination doctors should be required to have an active clinical practice and exams must be recorded

Independent Medical Examination Video

It’s encouraging that the recent bipartisan House package of No Fault reform bills is taking up the long-overdue issue of curbing the so-called independent medical examination (IME) abuse that is so rife in our system today, with insurance companies often relying on notorious defense doctors to cut off needed benefits to car crash injury victims and workers’ compensation claimants.

But it’s frustrating — and troubling — that some of these well-meaning lawmakers have failed to champion the two most desperately needed and most effective reforms for stopping the rampant IME abuse that is crippling the auto No Fault system in Michigan today:

  • The requirement that a “majority” of a doctor’s “professional practice” be devoted to “active clinical practice” — not doing litigation-related IMEs — should be applied to the IME doctors chosen by the Board, not just the doctors on the Board.
  • Videotaping of IMEs should be mandatory or, at least, easily obtained at the request of the attorney representing an auto accident victim who is being forced to submit to an IME.

Assuming Lana Theis on the House Insurance Committee ever gives these bills a chance by scheduling a hearing, my hope is that House lawmakers will adopt these proposals, which auto accident attorneys know are the only way to protect people and stop insurance companies from abusing IMEs to deny auto No Fault benefits to car accident victims.

Active clinical practice for independent medical examination doctors?

It’s not a new idea that doctors who conduct IMEs of auto accident victims should be devoting most of their professional time to caring for, treating and healing the sick and injured.

But it’s an idea that hasn’t received anywhere near the attention it deserves.

In 2009, the Insurance Commissioner proposed (but never acted on) the creation of an administrative rule that would require, among other things, the following of an IME doctor:

He or she has “devoted a majority of his or her professional time, during the year immediately preceding the date of the examination, to active clinical practice, and/or instruction of students in an accredited health professional school or accredited residency or clinical research program, within the medical specialty most relevant to the subject of the independent medical examination.”

Videotaping an independent medical examination protects car accident victims

Could you imagine a doctor who would testify under oath that a person said things that they never said?

It happens all the time.

Were it not for the videotaping of a very important IME, my client, Jim Fairley, a traumatic brain injury survivor, would very likely have lost his truck accident injury case because of the false statements that IME doctor Rosalind Griffin made about what he supposedly said to her during Jim’s IME.

We were lucky to have videotaped Jim’s IME. Although many states allow auto accident attorneys to record exams to protect clients and preserve the integrity of the exams, they are often not allowed  by Michigan courts.

Videotaping and recording exams is still the best way to document everything that occurs and most importantly what is said during an IME and, thus, holds IME doctors accountable to tell the truth.

As I wrote in my blog post, “It’s time to allow Michigan attorneys to record IME exams, insurance defense doctors”:

“What do these ‘hired gun’ [IME] doctors, and the insurance companies and defense attorneys who hire them, have to hide? That’s the real question we need to start asking when they vehemently fight to oppose [videotaping] IME exams and other measures that can protect the truth and integrity of these exams … [I]f they’re doing everything they’re supposed to in these so-called ‘independent’ medical examinations, and if these doctors who are hired by insurance companies are being honest, accurate and ethical, then they should welcome videotaping — not oppose it.”

What is an independent medical examination?

No Fault gives auto insurers the legal right to require car crash victims to submit to what are misleadingly called “independent” medical examinations by doctors who have been hired and paid by the insurance company.

Of course, like nearly everything else that insurers are permitted to do, they abuse this privilege endlessly, using the IMEs as setups for their hired-gun doctors to concoct any “excuse” for the insurer to deny or cut off No Fault benefits.

As I wrote in my blog post, “Personal injury attorney advice on ‘independent’ medical examiners in Michigan”:

“Independent medical exams are a game, and a perniciously evil one at that. These IME doctors make vast amounts of money, testifying 99 percent of the time on behalf of the defense. They almost always minimize the personal injuries or damages to the plaintiff based upon one-time, 15-minute exams. If these issues of bias are not exposed, then a jury may actually mitigate the damages and compensation that your client deserves, especially when many IME doctors write typically nasty reports ripping apart injured clients and saying there is nothing wrong with them.”

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