Thursday, May 14, 2009
May 14, 2009 The Ruff case on conflict of interest
Just decided today is the Ruff case. Back on July 25, 2008 I posted an earlier Court of Appeals case we'll call Benuishis. It appears that this latest case totally disagrees with the earlier division of the same Court. The Colorado Court of Appeals has over 20 judges and more then one division to handle the many cases that are appealed. Both cases involved a Division Independent Medical Examination. It is quite obvious there is now a conflict in divisions of the court which usually means the Supreme Court will have to resolve matters. In the meantime here is the situation: If a DIME physician may have a conflict of interest because he or she receives much income from a party (like Pinnacol Assurance which uses some doctors quite a bit) then the administrative law judge at the hearing may have to consider if there is a sufficient appearance of a conflict of interest to remove the doctor as a DIME. What is not clear is what is the appearance of a conflict. Benuishis says receiving a lot of income from a party like Pinnacol is not by itself the appearance of a conflict and Ruff says it can be. Personally I agree with Ruff. I just do not like close financial relationships with insurers to be disregarded. If anything frequent use of a doctor or paying that doctor many times over may well taint that doctor or make his use as a DIME questionable. As medical professionals they may not see it that way but we're talking about an appearance of a conflict. Sometimes it is not an actual conflict of interest but the appearance of one that is so disturbing. The Colorado workers compensation system set up the DIME process with the intention of really trying to make it totally independent. We honor that intent by excluding all who might make it appear suspicious. That's why Caesar divorced his wife.