Category Archives: IME

“Independent” (or are they “Adverse”!) Medical Examinations

Don’t get mad…get an attorney.

Today’s post comes from guest author Charlie Domer, from The Domer Law Firm.

Was your worker’s compensation claim just denied by an “independent” medical evaluator?  You are not alone.

Following a work injury, the insurance company legally can require the injured worker’s attendance with an independent medical evaluator, or IME.  The IME doctor is not the worker’s doctor, and the worker does not have to agree with the doctor.  The problem, however, is that many IME doctors disagree with the causation opinion of the treating physician, and then the IME opinion effectively serves as the default legal opinion until the case either goes to court or is settled.   That means that the insurance company’s hired doctor can be used to cut off a worker’s benefits–forcing the case into litigation.

If the treating physician disagrees with the IME report, a worker should consult with an attorney to dispute the IME denial.  After all, the IME is hired by the insurance company.

A recent in-depth article pointed out the potential for bias by insurance company-hired IMEs: Long-time judge: Some ‘independent’ doctors routinely rule against injured workers.  For many in the work comp world, a more appropriate term for these hired doctors is adverse medical examination.  Certainly that is not true of all IMEs, but some physicians–especially those who are not actively seeing patients–seem to curry favor with the insurance company by denying a worker’s medical claim.

When the insurance company doctor disputes a claim, the injured worker needs their own treating doctor and their attorney to push back against the IME denial.

 

Work Comp Cost-Containment: IME Company May Fetch Billions

Today’s post comes from guest author Rod Rehm, from Rehm, Bennett & Moore.

In January, I wrote about how workers’ compensation has a cost-containment industrial complex that not only harms workers but also is a potential profit generator for groups like private-equity firms.

According to this link from The Wall Street Journal, a private-equity firm named Leonard Green & Partners LP recently submitted an offer to buy an IME company called Exam Works for $2.2 billion. Yes, that’s billion with a B.

“The insurance-defense-industrial-complex has become a multi-billion dollar enterprise,” as was noted on Aleksy Belcher Law Firm’s Facebook page earlier last week (Aleksy Belcher is a workers’ compensation plaintiff’s firm based in Chicago).

The Wall Street Journal article linked above talks about the hundreds of millions of dollars of revenue that Exam Works posted last year and also its purpose.

“It said it serves more than 6,000 clients globally, including property and casualty insurance carriers, law firms, third-party claim administrators and government agencies, helping them manage costs and enhance their risk-management and compliance processes,” according to The Wall Street Journal.

What this means for injured workers and their loved ones is that the big business and added bureaucracy of “cost-containment” may translate to even more profit at the expense of injured workers, going into the private-equity company’s pockets if the sale goes through.

The way IME companies are seen as potential profit centers for private-equity firms is one of the many reasons that if an IME – Independent Medical Exam – or DME – Defense Medical Exam – is ordered for an injured worker, that injured worker should seek the advice of an experienced workers’ compensation lawyer. Workers’ compensation lawyers advocate for injured workers and help them understand the workers’ compensation process, including IMEs, so the playing field of the workers’ compensation process might be a little more even. That way, cost containment, though not as profitable for private-equity firms, can give way to injured workers getting the medical treatment and compensation that they need to move on with their lives.

What Does That Stand For? Commonly Used Acronyms in Workers’ Compensation Cases

Today’s post comes from guest author Brianne Rohner, from Rehm, Bennett & Moore.

Every profession has certain turns of phrase or acronyms they use on a daily basis that, to the layperson, mean very little and may only serve to add confusion to an already difficult issue. The legal profession and the representation of injured workers is no different. Injured workers often find themselves traveling down a confusing road armed only with directions written in an unfamiliar or foreign-sounding language. The experienced attorneys at our firm navigate clients down this road on a daily basis.  

Below is a list of commonly used acronyms to assist in understanding what is happening with your workers’ compensation case when everyone around you is suddenly speaking another language. Please keep in mind that the accompanying definitions are very general, and you should seek the advice of an experienced workers’ compensation attorney for more information or assistance with your case. Please also see the links for other blog posts for more information on some of these issues.