There was an interesting piece in the New York Times last week about the business of independent medical exams (IMEs) of injured workers who had filed claims against their employers. The story detailed the pressure often placed on the physicians conducting the exams to produce a report that is favorable to the insurance company, who also happens to be paying the physician’s fee. Not everybody believes the system is broken, but the apparent conflict of interest does raise several red flags.
The obvious victim in this situation is the injured worker. The Times piece focused on New York state’s workers’ compensation system And that system’s deficiencies is no different here in the Sacramento area, and throughout California.
The independent exams are designed to flush out workers who exaggerate injuries or get unnecessary care, and there is no question that some of that goes on. As a check on what a worker’s doctor determines, insurers are allowed to order an ostensibly neutral exam by a doctor they select and pay for. They do so regularly, with more than 100,000 exams conducted in New York state each year. The numbers are just as high in California.
Dr. Samuels, 79, stopped doing surgery years ago. Until recently he commonly filled his days performing insurance exams on workers, sometimes as many as 50 in an afternoon, he said in his small office in Borough Park, Brooklyn. You obviously can’t spend a lot of time with that volume pushing up your back,” he said. “You have to assume there are going to be errors. Look, there are a lot of holes in this thing.”
At times, evidence shows, Dr. Samuels’s official reports were quite different from what he appeared to find during an exam.
“I don’t,” he said. “That’s the problem. If I read them all, I’d have them coming out of my ears and I’d never have time to talk to my wife. They want speed and volume. That’s the name of the game.” Dr. Samuels said he generally received about $100 for one of these exams.
The exposure of these practices in New York should not be considered unique to that region of the country. Here in California similar problems exist not only with Workers’ Comp cases, but personal injury cases as well. You need to be alert to similar practices where defense medical exams are used. This is where having the guidance of seasoned legal counsel is crucial. Counsel will be able maintain a visible presence during the process to increase the likelihood the client will get a fair shake from the defendant’s medical examiner.
For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.