Insurance IMEs Beware! Your Time Has Come

It's no surprise that IMEs often come back with the opinion that the insured has no right to benefits, thus saving the insurance company money. And of course, if you're the insurance company, the doc that consistently tells you that you don't need to pay is the doc that is going to consistently get your business, right? Good business practices and honest insurance don't often go hand in hand and that is certainly a problem seen by many today.

Fortunately, there is some legal recourse that can be taken against IMEs, further strengthened by a recent case out of Arizona. An IME hired by an insurance company to review a worker's comp claim found that there were no reasons for an employee to be held out of work. The IME completely missed the spinal cord compression. When it was finally caught, not even surgery could save the cord. The guy was in such pain that he accidentally overdosed on his meds and his father added "wrongful death" to the medical malpractice suit already in the works.

So the court found against the IME, citing laws that did not require a traditional doctor-patient relationship for a "duty of care" to exist. That means that IMEs have the same responsibility to objectively examine patients as a person's primary care physician. Hopefully this will serve as a warning to IMEs that they can't just ignore medicine while shirking responsibility.