Personal Injury Law

Injury Exam Scam: Doctors Deliver Diagnoses to Keep Getting Paid by Insurance Companies

By Jim Reed

“A World of Hurt” is right.

Last April, the New York Times ran an in-depth expose of the New York State workers’ compensation system. The articles and associated videos and resources ran under the umbrella title, “A World of Hurt.”

What did the Times discover? I quote: “New York State’s workers’ compensation system serves no one well and is arguably the most adversarial of any state in the nation.”

IME: The test doesn’t deliver the truth

As a personal injury attorney in New York and Pennsylvania and managing partner of the Ziff Law Firm – which has a Workers’ Compensation and Social Security Disability group headed by attorney Eric Johnson – I’ve long felt strongly about some of the issues this series examined.

In particular, I’m galled about the practice of giving injury victims insurance company-ordered, so-called “Independent” Medical Exams, or IMEs, to prove the validity of injuries. These exams are NOT INDEPENDENT.

As a doctor was quoted in the story: “If you did a truly pure report… 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.”

Check out the video embedded in this post, depicting a typical IME given by a semi-retired doctor WHO DOESN’T TAKE NOTES.

You can hear the doctor describing the patient’s pains and limitations in the video. The insurance company report of the exam was that the patient was healthy and did not have a valid workers’ comp claim.

When questioned about the different results, the doctor denies responsibility. It must be the fault of the appointment booking agency that transcribed his notes, or the insurance company, he says. Without the video record, it’s the patient’s word against the doctor’s. Guess who wins that bout.

How can insurance companies pay for “independent” exams?

IMEs are meant to flush out people who are faking or exaggerating their injuries. More than 100,000 of these exams are given each year in New York State.

The big irony of the system is that the people who are truly hurt – workers who are suffering both physically and financially – are often further victimized by the system. Their cases get ground to dust by the interlocking gears of the big insurance companies, the “expert” doctors who are essentially paid to save the insurance company money, and the “entities” – exam booking and transcription agencies – who give the doctors and the insurance companies plausible deniability.

Check back on the NY Injury Law Blog soon for my tips about IMEs. My recommendations are based on experience advising clients for more than 20 years. It’s a must-read for clients before they have what I refer to as their “Insurance” Medical Exam.

Thanks for reading,
Jim
_________________________________________
James B. Reed, Esq.
Personal Injury & Malpractice Attorney
Ziff Law Firm, LLP
303 William St., Elmira, NY 14902
Tel. (607) 733-8866 Fax. (607) 732-6062
Toll Free 1-800-943-3529
mailto:jreed@zifflaw.com http://www.zifflaw.com

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Full post as published by New York Injury Law Blog on January 22, 2010 (boomark / email).