Friday, November 20, 2009

The New Rule 8 on Insurance IME exams

If a claimant is being sent for an IME (Independent Medical Examination) by the insurance selected doctor then there is a new rule, effective November 1, 2009 that is applicable. The hew rule came about because of a new statutory provision which requires that these exams be audio recorded. The new rule is worth reading and allows discovery of the audio and more. The point in my view is to keep the exam honest and relevant so it allows the claimant some recourse to protect him or her from exams which contain irrelevant and confidential information that should be stricken. It will be interesting to see how this plays out over time.
UPDATE December 2010: Received a recent comment that accused a Denver doctor, Dr F. of stopping the audio when she deemed it and specifically when she deemed the patient question as not valid enough. While I cannot post the comment without verification I certainly can say that once the audio starts I would consider any tampering with it as an improper alteration which violates the rule. That could mean striking the report is one option for a judge. I can say that insurance IME's can be very one sided. Claimants may not have the resources to obtain their own IME but insurers often can do so. For many it is not a level playing field although a Division IME set up through the state can be a very important added method of reviewing treatment, rating and more. The insurance IME (not the same as a Division IME) often, but not always, is looked at as a hired gun for the defense. At times I have seen insurance IME's provide a worthwhile opinion but that is the exception rather then the rule. By the way the statute at 8-43-304(2)(a) does say that it should not be construed to prohibit a party from making their own audio recording of the exam.


Charli said...

we be sure the the recording won't be tampered with. I would have been much happier if there was more oversite on the IMEs. Insurance companies use these to browbeat wpi (work place injured) into low settlements. There needs to be a rule that if a specialist is located in the wpi's home town or near they aren't shipped to an IME hours away. Also filming of these "evaluations" should be allowed by the wpi. I've been trapped in WC hell for over 14 years now. Not one of the IME's has been honest. In fact during one IME the doctor said my injury wasn't work related but later when he saw me at the VA I not only was work related I had the disease I had been dx with by a specialist which the doctor had denied during the IME. Doesn't this prove the system is crooked? If our legislators had to go through this system they would change it to be fair for both the business and the wpi. Right now both are being sold down the river by the insurance industry and by judges who ALWAYS err on the side of the insurance companies.

Will said...

The fundamental question that has failed to be addressed by the state legislature is why?

Why are IME's called Independent Medical Evaluations? They are not independent, and under current practices cannot be.

Whether authorized by the insurance carrier, or the workers comp claimant attorney, the doctor doing the exam has a business relationship with whomever pays. That relationship leads to bias, some cases more than others.

Those doctors willing to be the most "cooperative" in their expert opinions, will in turn receive the most repeat business. That's simply the way the real world works.

If an IME's function were truly to provide an independent opinion, based on the best medical information possible, rather than the financial interest of either party, then it should be a blind study with no possibility of collusion for either side.

It's required for pharmaceutical trials, why should drugs be more important than injured workers?

The insurance industry has a right to protect themselves from fraudulent claims. They do not have a right to use the IME process to deny legitimate ones.

In my personal opinion, the latter is the most prevalent use of the IME in Colorado today.

insurance colorado said...

Wow - a very content packed blog.Nice lens with some very useful info

Truth said...

As far as tampering with the Audio Recording, it clearly happened in my case. I told the IME Dr. that I had medical condition MMMMMM three different times during her/his IMExam. I used words/phrases such as "really bad, very horrible, extremely painful", etc. to describe the pain.

Later, in the Doctor's IME Report, the Report said my pain for MMMMMM was "mild". Total lie, one of many lies in the IME Report !!! Other Drs. doing IME's believed the lies and repeated them in their reports.

When I listened to the audio CD, the 7 minute discussion about the MMMMMM was totally missing ! And the other two times I mentioned it are missing from the Audio CD as well !!!

How did this happen ? Ask Dr. Q !

Altering and editing and not Audio recording the ENTIRE IME should be punishable and the Dr. permanently barred from doing future IME's !

This was clearly NOT an "accident" but an intention, willful and deliberate act of collusion by the Dr. and the insurance company.