A small sampling of all the stories that are out there, all the same but with variations of circumstance. Some other tips on dealing with them. I will continue to add stories as I find them and can add, providing sources and links that document the all too well known reality of an IME.
JF from NM [Email printed with Permission]
Carol on the UNUM insurance IME [Email printed with Permission]
IME exams and workman's comp
Saw an IME today and it was one of the worst experiences I have ever
had. His examination was a joke. He had no records or films and
interrupted me every time I tried to tell him my history or my
symptoms. I had a lumbar fusion with bak cages and four months post op
developed more back pain and new radicular pain in my "good leg". Pre
op I had had right leg pain 4 months post op developed left leg pain.
Right now you people have more history on me tha he was willing to
hear. If you asked him right now which one of my legs hurt or where
the radicular pain is located he couldn't tell you. His exam was only
3 minutes long including the time I tried to talk to him. For range of
motion he moved me 20 degrees back, forward and sideways, he never did
rotation which is what brings on the radicular pain . He didn't want
to hear it when I tried to tell him my left hamstring and psoas mucle
are so short I can't rotate my left leg when it is extended. He did
six, yes six, usless, poor quality, lumbar xrays that when he brought
them in the room he admitted were useless and would tell him nothing,
aaah but he can bill for them. His sensory exam consisted of quickly
running his hands over my legs and saying can you feel this, well yes,
anyone who is not a paraplegic could feel some of that. For strength
he said push this push that with his hands changing position so fast I
couldn,t keep up with him. It was like being examined by Bruce Lee. He
pronouned my exam normal and then added that he did not think my job
was physically demanding, I am an echocardiographer and I push, pull a
450 pound machine and do ultrasound exams which require bending ,
twisting and lifting. When I said I needed to talk to him about my job
and his findings he said" no you don't, I am not treating you I am
evalutating you." My point I guess to you kind people is, if you are
on workman's comp. beware of the IMEs who are sometimes money grubbing
crooks who forgot that they once stood at their medical school
graduation and swore first and foremost to " do no harm."
This article submitted by Amy on 5/30/98.
Mass. General Hospital - Neurology Web Forum - Spinal Disorders.
Here is a list of responses that have been posted regarding this article...
* I wish (5/31/98) 5:45 PM
* IME?? (5/31/98) 5:31 AM
* Hey, Amy... (5/31/98) 12:45 AM
* Right on! (5/31/98) 12:21 AM
* Sharon, you said it........ (5/31/98) 12:12 AM
* You Said It Best!!! (5/30/98) 11:59 PM
* Jeez..... (5/30/98) 11:52 PM
* Sharon B (5/30/98) 11:50 PM
* Nope... (5/30/98) 11:32 PM
* Sharon B (5/30/98) 11:27 PM
* Try This (5/30/98) 10:39 PM
* Still friends??? (5/30/98) 10:24 PM
* Oh brother..... (5/30/98) 10:17 PM
* Hey, Jeff... (5/30/98) 10:12 PM
* SharonB (5/30/98) 8:18 PM
* IME Horror Story (5/30/98) 3:18 PM
* I also had an IME (5/30/98) 11:21 AM
* Get an attorney.... (5/30/98) 10:55 AM
* More advice... (5/30/98) 8:09 AM
* Good advice (5/30/98) 3:38 AM
* make a note (5/30/98) 3:33 AM
_________________________________________________________________
IME revisited
I've been gone from cyberspace for a couple of days, so this isn't
very timely. I do hope it is helpful, though.
The "IME" is SUPPOSED to be an "independent" medical exam, but in
reality it is an "insurance" medical exam. I NEVER expect an IME to be
fair, unbiased, or even an "exam." There are some strategies to
help...
By the time you are going for an IME, I hope you have a lawyer. If
your insurer asks for an IME, they are looking for a way NOT to pay.
Your attorney can, and should, find out how many exams the doctor does
for your (and other) insurer a year; how much that translates into in
terms of $$$, etc.
You can do some things too. Take along a tape recorder; ask to use it.
If the doctor says no, ask again and say you have trouble remembering
all that doctor stuff and just want to be sure you are clear. "No"
still? Give up, but rest assured you now have a doctor who is already
listening better than usual!
TAKE NOTES -- time in, what was asked, what was done, what was said,
time out, etc. You can take a paper and pen into the exam room -- the
doctor does after all, and it's supposed to be YOUR appointment. Ask
that copies of the doctor's report and test be sent to your treating
physician immediately, too.
DO NOT expect the IME to be in your favor. EXPECT to read that you are
a lying/sniveling/malingering faker who should be out doing olympic
powerlifting without a twinge. (OK, that may be reading between the
lines, but you get the idea.) DO NOT TAKE THIS TO HEART; TAKE IT TO A
GOOD WORKER'S COMP ATTORNEY. Unless it's true, of course.
Worker's comp isn't an easy thing because although you pay in, they
don't want to pay out. It's not profitable to pay out. Your employer
doesn't want a claim record because it affects rates. IME DOCTORS
don't want to say there's a problem with a patient because then they
aren't going to be IME doctors anymore.
My own experience with this? Seven years of law practice, and my own
problem, too. My auto insurance company sent me to a neuropsychologist
six months after a devastating car accident with an unisured motorist.
He did a MMPI and said I was a raging lunatic faker... THERE WAS NO
PHYSICAL EXAM WHATSOEVER. My "sin" in his eyes was that "She is smart
and know (sic) how to fake these problems since she is a lawyer" --
this quote was **actually** in the report, no between the lines
needed! He got $793 (in 1990) for the test and less than 5 minutes'
conversation with me. I know there were at least 5 other people
scheduled to benefit from his expertise for my insurer THAT DAY (I
looked at the schedule book when the receptionist was on the phone!).
I had three hip surgeries, two knee surgeries, a huge vascular repair
in my right leg, back surgery at two levels, and elbow surgery -- ALL
as a result of the injuries from this accident from which I was
"faking" injury. The ultimate justice was that I was hit by an SECOND
uninsured motorist coming back from the IME and my insurer with whom I
had uninsured coverage ended up "on the hook" for the second injury
too. Good thing -- my orthopedic "faking" cost nearly $130,000 (more
than one accident's worth of coverage), not to mention the year and a
half off of work and eight years of struggle SO FAR to get healthy.
The judge wouldn't let my insurance company try to apportion all the
injury to the first accident, which they tried, to get out of paying
the overages on coverage. (The second accident wasn't all that bad,
but the insurer wanted to say it was NOTHING and disallow any
coverage.) It was clearly "just money" to them, and the fact that I
had paid premiums to insure against just such a likelihood seemed to
offend them. They tried to make a case that I bought coverage so I
could use it!!? (I bought it because it was MANDATORY.)
TAKE WAY FROM THIS: DON'T be intimidated; DON'T be bullied: and DON'T
be surprised when the IME is not helpful. Concentrate on your wellness
and get someone to fight dirty if needed. I never thought I would
advise THAT last item, but I do now!
Good luck all.
This article submitted by Elizabeth on 5/31/98.
Mass. General Hospital - Neurology Web Forum - Spinal Disorders.
-------------------------------------------------------------------------
Re: IME -was monsters -and still is
Wed, 11 Jun 1997 14:52:59 -0400
Nancy:
1) What is the SOL (Statute of Limitations) in your jurisdiction? Can
they do that almost 6 years later????
2) Carriers have a right to IME. They also have a right to choose the
person who will conduct it, just as you have a right to an IME, and you
choose the professional who conducts yours (same goes for a second
opinion!).
3) If you are unable to travel long distances, which is my case, too,
than request the carrier arrange the transport. You can get it if the
doctor authorize your request, based on your medical condition. You say:
"I am willing to cooperate, but cannot travel long distances, how can you
help me get there?" Be polite with them, a light touch goes a long way.
There will always be enough time for the cavalry:)
4) Some of those you mentioned sound odd and romantic:) A doctor who
will meet you somewhere in a street corner?? What's that, a movie??
Are you being paid as an actress?
5) Whatever the carrier wants, ask them so substantiate *in writing*
In fact, what ever you do, do it in writing! Document, document,
document. I personally hate phone calls, and record them if I can
(I put them on the speaker phone, or use an answering machine).
All official matters much be processed through certified return receipts
letters, and you keep a copy!
Same, ask from the carrier to send you a letter delineating their
requests, etc. Once in writing, you have a powerful tool for later,
should you need to present that as evidence in a court of law.
Avoid the "he said/ she said" syndrome. It would be your word against
them. Do you need the stress??
6) When you receive the letter requesting you undergo an IME, send
them back one, cert/return receipt, ask for reasonable accommodations
befitting your medical needs, i.e., transport, to and from the place,
hotel accommodations, if they should cover it, and whatever else you
need and want. Don't accept phone calls as acceptable replies, ask
them to respond either by fax or in writing! You must always have
evidence of facts from your point of view; theirs will usually be
different:)
7) Ask if you could record/audiotape the session of the IME, if they
say no. Get it in writing. Cooperate with your IME, be as consistent
as you can. Ask to go over the IME results with the specialist prior
to releasing the information to the carrier, if possible. Debate it
if you feel the need for! Don't accept anything, or take it for
granted. Just because they are doctors does not mean you are an idiot,
and should dance to their drums.
I build my own drums and we have a jazz concert..:) Be proud of who you
are, regardless of your disabilities. You are a person, first and
foremost.
8) Seeing a psychiatrist is not uncommon as they are MDs. You can't
have a non-MD as your primary care physician, and usually in court they
prefer MDs. Hence the power of psychiatrists in courts, but there are
also very good forensic psychologists! It's not because you are crazy
(you can't be more than a psychiatrist:) It's just the routine of it.
9) IME is when there is a dispute between the carrier and yourself due
to conflicting reports. 2nd opinion is when you, or the carrier,
disagrees with a certain report's findings, like you dispute its
validity. IME is done by a third party (who is supposed to be unbiased,
but is not!) looking at the conflicting reports, ask you specific
questions, and determine which one is more "right", etc. An NP IME
does not call for a third battery of NP
tests! A second opinion will! But, it can usually be done a year later
as you can't be asked to undergo a battery of tests twice within a
year--they won't be valid, and/or reliable. Makes sense now?
10) You have a lawyer, what does he tell you?? Also, you live in
Canada, I am not familiar with their rules, so it might be different
over there.
11) Can you use your health insurance to get other opinions to bolster
the ones you already have, that support your medical claims? I think
you have an excellent case from your post here. You have enough proof
of injury and damages. The carrier is just playing a "war of attrition"
with you. Why am I not surprised??
Have I missed anything?
Love,
Yaron.
At 11:04 AM 6/11/97 -0400, David & Nancy Fudge wrote:
>Dear Yaron;
>I was very interested in your reply to Sherry about IME.The insurance
>company who represents the man that hit me now after 5 1/2 yrs wants
>"to invoke their right" for an independant medical in Toronto Ontario
>which is 250 miles away from me.I am to be there Friday morning for all day
>testing with a psychiatrist(yes of course, I can't be brain injured.
>I must be crazy!!) They are NOT paying for a hotel room Thursday night.
>Saturday I am to meet some psychologist on a street corner in
>Toronto!!and she will take me somewhere to be tested because her office
>is closed that day???? I live in a small city and I can't get to doctors
>appointments or anywhere without a fistful of maps, as I frequently lose
>my way. I will be going along and suddenly absolutely nothing looks
>familiar to me. I have lived here 24 years.Sunday I am to stay in
>Toronto and be on my own. Monday I am to be tested all day by a
>physiatrist(I think) and then go home. They will not pay for a room
>for Monday evening either.Like everyone else I get huge fatigue, dizzy
>spells and monstrous headaches when stressed and overtired.They refuse
>to pay for anyone to accompany me.My husband is too ill to accompany me
>He was just diagnosed a couple of months ago with a brain tumour and
>brain atrophy and he has lost 100lb in 6 months.My doctors said "NO Way"
>My lawyer said bring your doctors here or pick local
>specialists.Kingston is the major medical centre between Montreal and
>Toronto. The insurance company said ,"NO" and they have taken it to
>court to force me to go .
>On another point, I am interested in your statement that an IME is NOT a
>second opinion but merely an IME and can you explain the difference.
>This is very important to me right now.My own insurance company(who have
>been out and out bastards)wanted an IME questioning my SPECT scan that
>showed moderately severe damage throughout the entire brain.I had had
>two SPECT's , an MRI, a CT as well as a series of spine , abdominal
>andwrist and leg Xrays. My docs again said ,"Enough!!!"so my insurance
>company sent the brain scans to the doctor in London , ON. Without my
>knowledge, my rehabilitation worker(I have another name for her but ,not
>for publication)sent him my whole file. He not only commented on the
>scans but said I had arthritis in my neck pre-accident(luckily I have
>Xrays showing my neck to be perfect about 7 months before the accident)
>He also stated that I needed to be admitted to a program in Hamilton,
>Ontario for brain injuries.This guy is a radiologist. He has never in
>his life seen a patient ,except in a hallway. He certainly never saw me.
>The he sent ALL my files to another doctor in Toronto who had more
>expertise than him in MRI's, without my consent.Now my insurance company
>says I HAVE TO go to the Hamilton Psych Hospital.....Dr.R says so!
>What I found out on my own was that this program is for "dangerous,
>violent, people who cannot be managed at home or in a regular brain
>injury program". I have 2 vertebrae in my neck compressing on the spinal
>cord. My neurosurgeon says one good fall, one push or hit on the head or
>neck could cause permanent paralysis and they are going to lock me in
>with violent people based on an IME who never set eyes on me. They are
>taking it to court to force me....yes they DO know the risks. At the
>present time I am charging the doctor with malpractice but it looks like
>I am going to lose based on the fact that he got "extra" permission from
>my rehab. worker, who in fact was taking orders from the insurance
>company......interestingly, she now works full time for the insurance
>company
>Thanks for any and all information
>Nancy Fudge [Email address deleted]
>
>
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