In an investigative report, the New York Times released a story on the strong bias of so-called “Independent Medical Exam” (IME) doctors for insurers. The report confirms what plaintiff’s lawyers have been arguing for years: these defense medical exams, more appropriately called DME’s, are nothing but additional tools for claim denial by insurance companies.
Any time a plaintiff makes a claim for personal injuries, insurers request to have the client examined by a physician of their choosing. Prior to litigation, insurers cannot require an exam, but once a lawsuit is filed, the rules allow them to insist on having an examination. It is in extremely rare circumstances that a defense medical exam confirms an injury. On most occasions, these reports tell the insurers just what they want to hear, and the insurers in turn, deny the claims.
One doctor even admitted in the NY Times report that he cannot be truthful about injuries. “If you did a truly pure report,” he said, “you’d be out on your ears and the insurers wouldn’t pay for it. You have to give them what they want, or you’re in Florida. That’s the game, baby.”
The Times reviewed case files and medical records and interviewed participants for its reports. The findings showed that the exam reports are routinely tilted to benefit insurers by minimizing or dismissing injuries.
Like New York, several Massachusetts companies have made a big business out of defense medical exams. These companies provide lists of doctors to insurance companies, provide office space for examinations, and provide templates for doctors to fill in for the reports. In some cases, we attempt to protect the client by sending a lawyer or nurse to accompany the client to the exam. In others, we seek an audio or visual recording of the exam. Insurance companies, defense lawyers, and doctors routinely oppose these efforts at leveling the playing field.
It was refreshing to read the New York Times report which confirmed many of the problems with these tilted examinations. Hopefully, this report will lead to greater juror skepticism or greater regulation of the medical exam industry.
To see the full New York Times report, click here.
The Canadian Medical Association Journal reported: “After years of warnings from former United States president George Bush that frivolous medical malpractice lawsuits were driving doctors out of practice and inflating the cost of US health care, the weight of evidence now points to preventable errors – not misguided lawsuits – as the real source of the concerns.”
The article highlights and contains links to a number of studies that demonstrate that medical malpractice lawsuits do not inflate the cost of healthcare. In fact, malpractice insurance and claims account for, at most, 2% of US health care spending, according to the US General Accounting Office, the investigative arm of Congress.
Tom Baker, a law professor at the University of Pennsylvania, said that the “real problem…is ‘not too much litigation, but too much malpractice.'” He said, “The political debate has begun to refocus, a reflection that the real malpractice problem concerns the number of injured patients who don’t receive compensation…The political rhetoric has shifted pretty dramatically in that direction.”
You can view the full article by clicking here.