I strongly believe in the independent medical examination (IME) system. There are far too many doctors in every profession who are not following E&M protocols and never claim MMI (maximum medical improvement) has occurred for their patients, which has caused financial stress for many private and public carriers.
As the executive director (president) of my state organization in the early 1990s, I spent a considerable amount of time in my state capital fighting this system when it first started to become imbalanced. Since then, I have spent countless hours fighting this corrupt program. (I can safely say "corrupt," as I have been offered significant riches if willing to follow IME-mandated guidelines of improprieties).
A few years ago, I realized I had to stop fighting the unfair conclusions of the hired doctors and IME companies the carriers hired because a doctor is fully entitled to his/her opinion, no matter how crazy it may appear to a reasonable clinician – even those who practice in an evidence-based environment and document the case better than Thomas Jefferson did in crafting the Declaration of Independence.
Understanding the Problem
There are two salient points that must be understood about IME doctors. First, they are hired by the carriers' middle men, IME companies, so the carriers can state they get independent opinions, often with very specific parameters, as to what diagnoses can be used and the maximum scope of future care they are allowed to recommend.
Second, the IME doctors do not realize the carriers have brilliantly shifted the liability of any inappropriate actions to the IME doctors who accept this extremely high risk for a "piece of silver." When investigating the malpractice coverages for IME and peer-review doctors, a national survey of almost every chiropractic coverage revealed little to no coverage for "third party" services, leaving the doctor liable and the carriers' judgment as proof as they order independent reports insulating them from any legal issues and mitigating potentially large financial losses. This is a fact very few IME and/or peer review doctors realize.
The caveat to those doctors: Read your policy carefully. At best, see what your coverage buys you in this arena and be prepared lose everything if you get sued. There is no such thing as a "benevolent carrier."
Many doctors hide behind the "no doctor-patient relationship has been established" caveat. In most states, this is actually contrary to state laws regarding duty of care and ultimately means nothing. It will not protect you. Therefore, your IME examination and peer-review standards are the same as if you had directly treated a patient, and you are held to the same standard of ethics and patient care.
Some states allow you to hide behind that statement, but case law has been further defining that statement nationally, and it still leaves the IME doctor exposed to slander, fraud, licensure and other related issues that both the IME and peer-review doctors have to defend independently with little to no malpractice, business overhead coverage or carrier backing. Again ... caveat emptor.
Fighting Back
Over the past 3-4 years, many doctors nationally have been reviewing state laws on ethics and practice standards, and have been holding the IME and peer-review doctors who have been performing and reporting improperly to their licensure standards accountable. The mechanism is through reviewing their reports and seeing if they omitted critical documentation previously submitted or handed to them during an examination, and then reporting them to their licensure boards for a violation of their license standards.
These complaints have been done both by the doctors and the patients – who are the real victims in this scheme. As a result of working with doctors in 47 states, I have been able to get an overview of how successful this process has been.
My first experience is from something I directly participated in. A doctor in New Jersey, having read an improper report, made a complaint to the licensure board and the lawyer in the personal-injury case submitted the case in court papers, making it public record. I then reported this, including the doctor's name, as it was public record in a presentation I gave to 150 lawyers a week later.
Soon thereafter, I received a letter from his lawyer threatening a lawsuit for defamation, demanding a public and written apology as well as a retraction. This chiropractor was earning $650,000 annually for doing IMEs, and the carrier fired him based upon both the letter of complaint and my comments, as there were carrier representatives in the room. I wrote the letter and said, "Dear Dr. XXX, I apologize that you lied and I caught you. If you don't lie again, I won't do it again." Matter closed; I never heard from him and he never got his job back.
In addition to rendering a licensure complaint against the doctor, if the IME doctor performed an improper IME or peer review and lied through omission of any other type of inaccuracy, overtly or not, we are also demanding the carrier pay our claims in full based on rendering the full facts of the case. Should the carriers continue to deny payment, a complaint will then be sent to the state's attorney general for the carrier being complicit with the IME doctor in an apparent scheme and creating a public health risk.
According to Ron Manoni, DC, a practicing chiropractor for 35 years in Connecticut who has retired from active practice and now limits his activities to helping doctors rebut improper IMEs and peer reviews, "The bullying and arrogance of the IME doctors and carriers have become commonplace in our industry and simply reading those improper reports will give you the proof required to both get paid and commence a licensure action against the hired doctor. This will begin the process towards fairness by holding those perpetrators to the same standards we are all held to: the truth."
Doctors in New York, New Jersey, Massachusetts, Georgia, Florida, Texas, Colorado, Nevada, Oklahoma and many other states are now reporting their denials are being overturned, licensure investigations are being performed and in many instances, the treating doctor's patients are no longer subject to IMEs or peer reviews. It appears carriers are choosing to profit from those doctors who give permission by never fighting back. A bully's haven! It's time to take a stand and overturn this carrier-created public health risk.
Dr. Mark Studin is an adjunct associate professor at the University of Bridgeport School for Chiropractic, teaching advanced imaging and triaging chronic and acute patients; and an adjunct postdoctoral professor at Cleveland University-Kansas City College of Chiropractic. He is also a clinical instructor for the State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Office of Continuing Medical Education. Dr. Studin consults for doctors of chiropractic, medical primary care providers and specialists, and teaching hospitals nationally. He can be reached at
or 631-786-4253.