Friday, July 25, 2008

Conflict of Interest Recent Case

On July 24, 2008 the Colorado Court of Appeals issued a case dealing with conflict of interest. The claimant was involved with the Division IME process. The DIME doctor received over 1/3 of his income from the insurance company as a regularly used provider and advisor to the insurance (Pinnacol). A DIME doctor is supposed to be truly independent and medically provide an opinion on treatment and impairment. He or she is not a treating doctor who is often designated by the employer/insurance to treat a claimant. Here the DIME doctor had close ties with the insurer but not on the specific case itself. The ties were from other activities although anyone receiving 1/3 of your income from contractual arrangements would seem pretty close to an insurer. The Court of Appeals determined this was not a conflict of interest and upheld the DIME doctors opinion in the case. Now many of us, even claimant attorneys obtain much income from insurance companies although we obtain it in an adversarial way (we battle with them). But having close contractual ties does seem to be at least an apparent conflict of interest. The mere receipt of money from insurance companies is not a conflict because if it were nearly all doctors would be deemed in a conflict of interest situation. So it is not an easy task to assume a conflict of interest exists from dealings with the insurance. It can be a question of fact but I am personally uncomfortable with the decision. If an attorney had a rather close relationship with an insurer he would likely not take a case against them. But doctors are not usually adversarial and getting paid by insurance does not mean there is a conflict. Anyway read the case here.

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