The Myth of the “Independent” Medical Exam

The New York Times is out with a story about independent medical exams – or IMEs – in the state’s beleaguered worker’s compensation system. The article more or less confirms what injury attorneys all over the county already know: there is nothing “independent” about IMEs.

Generally speaking, an insurance company in a personal injury or workers compensation claim has a right to conduct a medical exam of the claimant to confirm the injuries are legitimate. But what usually happens is the doctor – hired by the insurance company – will issue a report that either dispute, denies, or down-plays the injury.

The Times article (which can be found here) starts with the story of plumber, injured on the job, who seeks more time under his work comp claim. The doctor conducts an exam, and appears to confirm all of the plumber’s injuries and complaints of pain. But when the doctor issued the report, it reported the plumber had no injuries. According to the doctor, he couldn’t be truthful because it would hurt is standing with the insurance company:

“If you did a truly pure report,” the doctor said, “you’d be out on your ears and the insurers wouldn’t pay for it. You have to give them what they want, or you’re in Florida. That’s the game, baby.”

So who gets screwed? The injured person, now twice victimized. While this doctor is in New York, he has many brethren in San Diego. There are IME doctors here who make hundreds of thousands of dollars working for the same insurance companies, and who routinely issues reports that dispute the injured party’s claims, or disparage the character of the victim.

I had a client who had her tongue pierced. She suffered a neck injury in a car accident and was sent to an IME with a particularly notorious San Diego defense doctor. When the report came back, the doctor spent a paragraph talking about the black spot on the x-ray with turned out to be a piece of jewelry in the woman’s tongue. He went on to call her a malingerer (a liar), and concluded that she had no discernable injury.

What did a tongue piercing have to do with her neck injury? Nothing, of course. It was just this doctor’s way of diminishing the character of the patient before him, hoping that somewhere down the road, either an insurance adjuster or jury, will judge her wrongly and reduce the value of her claim. I guess “that’s the game, baby,” but it is a pathetic game indeed.