Tuesday, June 22, 2010

Supreme Court reverses Court of Appeals in Ruff

Yesterday the Colorado Supreme Court issued a decision in the Ruff case. The issue posed to the court and at the original hearing was over a possible conflict of interest in a Division Independent Medical Examination (DIME). The claimant argued that the physician had at least the appearance of a conflict of interest so how can the exam be fair and impartial. In the case the physician selected had received some $600 a month from Pinnacol (the insurer in the case) for being an advisor and also was in Selectnet the Pinnacol endorsed medical group. So it was argued that it was inappropriate and should have led to a disqualification of the physician. The ALJ (Administrative Law Judge) decided it was not a conflict and the Court of Appeals decided it might require more review by the ALJ. The Supreme Court decided the Court of Appeals went too far and that there was no conflict on the facts of the case. Merely receiving some money and being in Selectnet was not enough to establish the sort of conflict of interest to disqualify the doctor. The dissent noted that in Selectnet the physician received 25% of his income and since this might raise questions about impartiality that the Court of Appeals should have been affirmed. There really was no evidence that the doctor was not professional and objective but his status as a Pinnacol advisor and being in Selectnet seemed to raise a question about his objectivity.

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