Guest guest Posted January 19, 2012 Report Share Posted January 19, 2012 Good morning doctors, There are times when I’m not surprised by an IME request. This one though has me extremely baffled. Have a patient who was in an auto accident in the beginning of October. He suffered a compression fracture of L2 to go along with a pretty nasty lumbar strain. Patient has been seen 12 times since the accident. A re-evaluation took place approximately 8 weeks into treatment. The exam noted vast improvements, with an estimated MMI date and included our plans as we move forward in regards to treatment/rehab. Our office manager called the adjuster to see if we could provide some answers that perhaps they were missing etc. and the adjuster was extremely unprofessional and rude. The state farm adjuster proceeded to tell her that it was their prerogative whether or not to send the patient to the IME and that they needed to find out if the treatment was necessary. She then proceeded to hang up on our office manager. We haven’t received written notice of this IME yet. The patient is requesting a change in the adjuster and will piggy back our complaints to the State of Oregon about this adjuster. Clinically there is NO justification for an IME. He’s only 12 visits in, and has begun re-strengthening portion of care. They contacted the patient about this after the 8th or 9th visit. Just wanted to share a case with you that quite clearly depicts the complete ARBITRARY manner in which these exams are ordered. It’s absolute BS! ph Medlin D.C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2012 Report Share Posted January 19, 2012 Joe: Claims adjusters are under the gun to get claims closed, and it sounds like this one is under a Howitzer. When this occurs and another party is at fault, I advise the patient to acquire a good P.I. attorney and assure them that they can continue their treatment until they have reached maximum improvement and be released from care. Of course, I try to steer them to a reputable attorney we know will protect our bill at settlement. A well-respected orthopedic surgeon here in Salem, now retired, once told me that it often takes 1-3 years for people to fully recover from their injuries, and even if active treatment was concluded, he always advised his MVA patients to wait a full 12 months post accident before settling their claim. While that may seem ludicrous to the insurance companies, I think it's sound advice coming from someone with over 40 years experience seeing thousands of MVA cases. Lyndon McGill, D.C. Salem, Oregon www.SalemSpineClinic.com www.LimitlessRelief.com > Good morning doctors, > > There are times when I’m not surprised by an IME > request. This one though has me extremely baffled. Have a > patient who was in an auto accident in the beginning of > October. He suffered a compression fracture of L2 to go > along with a pretty nasty lumbar strain. > > Patient has been seen 12 times since the accident. A > re-evaluation took place approximately 8 weeks into > treatment. The exam noted vast improvements, with an > estimated MMI date and included our plans as we move > forward in regards to treatment/rehab. > > Our office manager called the adjuster to see if we could > provide some answers that perhaps they were missing etc. > and the adjuster was extremely unprofess and rude. > The state farm adjuster proceeded to tell her that it was > their prerogative whether or not to send the patient to > the IME and that they needed to find out if the treatment > was necessary. She then proceeded to hang up on our office > manager. > > We haven’t received written notice of this IME yet. The > patient is requesting a change in the adjuster and will > piggy back our complaints to the State of Oregon about > this adjuster. > > Clinically there is NO justification for an IME. He’s > only 12 visits in, and has begun re-strengthening portion > of care. They contacted the patient about this after the > 8th or 9th visit. > > Just wanted to share a case with you that quite clearly > depicts the complete ARBITRARY manner in which these exams > are ordered. It’s absolute BS! > > > > ph Medlin D.C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2012 Report Share Posted January 20, 2012 Dr. Medlin, Often there are issues that trigger an IME that you are not aware of, and this leads to the confusion you expressed. I am not saying these are the answers to your questions, but this may represent some of the factors. You do not mention the nature of the collision; however, you report that the patient was diagnosed with a compression fracture. Does the mechanism support this type of injury? Does the imaging show this as acute or a long standing condition? Is there any prior history of similar injuries - is he a "frequent accident" victim? Has he been truthful with you? Is there something about the accident he has not shared with you? Was there a delay in starting treatment? It may have nothing to do with you in particular, but there is something about the case that needs clarification. The issue may be something that cannot be shared with you, because it relates to an active investigation; this patient might be part of a bigger accident scam and you are an unwitting victim. Or the patient's name is the same as (or similar to) someone they are investigating. But all this is speculation. Your role is to treat the patient and provide good clinical documentation in support of your care. Contrary to popular belief, not all IMEs result in care being cut off. Although one of the biggest problems relates to poor record keeping (illegible, repetitive, contradictory, etc). I do not know if this helps, but there are different frames of reference to consider. Tom Freedland, DC Unnecessary IME Posted by: "ph Medlin" spinetree@... Thu Jan 19, 2012 8:57 am (PST) Good morning doctors,There are times when I’m not surprised by an IME request. This one though has me extremely baffled. Have a patient who was in an auto accident in the beginning of October. He suffered a compression fracture of L2 to go along with a pretty nasty lumbar strain.Patient has been seen 12 times since the accident. A re-evaluation took place approximately 8 weeks into treatment. The exam noted vast improvements, with an estimated MMI date and included our plans as we move forward in regards to treatment/rehab.Our office manager called the adjuster to see if we could provide some answers that perhaps they were missing etc. and the adjuster was extremely unprofessional and rude. The state farm adjuster proceeded to tell her that it was their prerogative whether or not to send the patient to the IME and that they needed to find out if the treatment was necessary. She then proceeded to hang up on our office manager.We haven’t received written notice of this IME yet. The patient is requesting a change in the adjuster and will piggy back our complaints to the State of Oregon about this adjuster.Clinically there is NO justification for an IME. He’s only 12 visits in, and has begun re-strengthening portion of care. They contacted the patient about this after the 8th or 9th visit.Just wanted to share a case with you that quite clearly depicts the complete ARBITRARY manner in which these exams are ordered. It’s absolute BS!ph Medlin D.C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2012 Report Share Posted January 20, 2012 I hate to agree with Tom, but I considered the same thing. (Just kidding Tom, don’t close my claim! ;-) Years ago, I had 2 patients who were ordered to an IME and the adjuster wouldn’t even speak to me (it was before I was famous). It turns out that they had been in an identical accident a year before, rear ended by a rented U-haul truck just like before. They were busted for mail fraud, insurance fraud, etc. Nice guys too. -- E. Abrahamson, D.C. Chiropractic physician Lake Oswego Chiropractic Clinic 315 Second Street Lake Oswego, OR 97034 503-635-6246 Website: http://www.lakeoswegochiro.com From: <TFreedland@...> Date: Fri, 20 Jan 2012 14:32:24 -0500 (EST) < > Subject: Re: Unnecessary IME Dr. Medlin, Often there are issues that trigger an IME that you are not aware of, and this leads to the confusion you expressed. I am not saying these are the answers to your questions, but this may represent some of the factors. You do not mention the nature of the collision; however, you report that the patient was diagnosed with a compression fracture. Does the mechanism support this type of injury? Does the imaging show this as acute or a long standing condition? Is there any prior history of similar injuries - is he a " frequent accident " victim? Has he been truthful with you? Is there something about the accident he has not shared with you? Was there a delay in starting treatment? It may have nothing to do with you in particular, but there is something about the case that needs clarification. The issue may be something that cannot be shared with you, because it relates to an active investigation; this patient might be part of a bigger accident scam and you are an unwitting victim. Or the patient's name is the same as (or similar to) someone they are investigating. But all this is speculation. Your role is to treat the patient and provide good clinical documentation in support of your care. Contrary to popular belief, not all IMEs result in care being cut off. Although one of the biggest problems relates to poor record keeping (illegible, repetitive, contradictory, etc). I do not know if this helps, but there are different frames of reference to consider. Tom Freedland, DC Unnecessary IME </message/45119;_ylc=X3oDMTJyZm11dnRsBF9TAzk3MzU5NzE1BGdycElkAzE0MDU5MjAEZ3Jwc3BJZAMxNzA1MDYxMTQ2BG1zZ0lkAzQ1MTE5BHNlYwNkbXNnBHNsawN2bXNnBHN0aW1lAzEzMjcwNzA0NDA-> Posted by: " ph Medlin " spinetree@... <mailto:spinetree@...?Subject= Re%3A%20Unnecessary%20IME> Thu Jan 19, 2012 8:57 am (PST) Good morning doctors, There are times when I’m not surprised by an IME request. This one though has me extremely baffled. Have a patient who was in an auto accident in the beginning of October. He suffered a compression fracture of L2 to go along with a pretty nasty lumbar strain. Patient has been seen 12 times since the accident. A re-evaluation took place approximately 8 weeks into treatment. The exam noted vast improvements, with an estimated MMI date and included our plans as we move forward in regards to treatment/rehab. Our office manager called the adjuster to see if we could provide some answers that perhaps they were missing etc. and the adjuster was extremely unprofessional and rude. The state farm adjuster proceeded to tell her that it was their prerogative whether or not to send the patient to the IME and that they needed to find out if the treatment was necessary. She then proceeded to hang up on our office manager. We haven’t received written notice of this IME yet. The patient is requesting a change in the adjuster and will piggy back our complaints to the State of Oregon about this adjuster. Clinically there is NO justification for an IME. He’s only 12 visits in, and has begun re-strengthening portion of care. They contacted the patient about this after the 8th or 9th visit. Just wanted to share a case with you that quite clearly depicts the complete ARBITRARY manner in which these exams are ordered. It’s absolute BS! ph Medlin D.C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2012 Report Share Posted January 23, 2012 Not that anyone asked for a lawyer's perspective, but here's mine, based on my entire career representing crash victims and conversing daily with hundreds of other lawyers in the state doing similar work: 1. It's my strong suspicion that IMEs are generally ordered whenever care seems to deviate from what each insurer has decided is an acceptable, " usual " curve of treatment for a given " type " of crash. What that means in real life is that when there isn't either big vehicle damage or photos of big vehicle damage, clients won't be referred for IMEs. " Big " treatment for " small " crash = IMEs. Never mind that there is no useful predictive correlation between vehicle damage and injury a) risk, severity or c) duration in a given crash - the insurance companies don't want to hear that because: 2. Insurance is a business, plain and simple. Whenever the companies can plausibly/legally keep more premium dollars by paying out less on claims, they are going to do it. Little injustices compounded by millions of policyholders equal billions of dollars in savings. With my own eyes, I've seen the internal reports to back that up. 3. There is nothing " independent " about the IME industry. Any doctor who performs IMEs either once or for a living knows who butters their bread. They know how easy IMEs are to do, and if they are a typical human being who wants the max reward for the least work, they will know what they need to say (or more likely, cut and paste from prior reports) to keep the gravy train coming. While it's true that I've seen a vanishingly small number of IMEs that either a) helpfully recommended additional, but alternative treatment that helped my client or completely agreed with a primary doc's course of treatment, it's equally true that I've never seen those doctors' names on a subsequent IME report. Why do you suppose that might be? It's because the carrier wants the report it paid for - the one that says " you're all done now, " or " you'll be all done in two more weeks, " or (I've seen this) " you couldn't possibly be hurt because your car sustained less than $1,000 in damage. " 4. Insurance fraud is a scarecrow, a bogeyman, used to prop up and legitimize a system whose true purpose is to limit costs whenever possible (see #2 above). Are there a handful of terrible people who attempt to manipulate the system for their own benefit? Sure. Are there some lawyers who abet such people? Sure. Those people are the 1%. The 99% are the people who suffered a legit injury in a typical crash and simply want their carrier to live up to their side of the bargain after the carrier has accepted their monthly premium payments, often for decades. Exaggerated accounts of the damage caused by the 1% are being used to victimize all of the rest of us when we make ordinary claims on our insurers following vehicle crashes. 5. Adjusters (the ones who order IMEs) don't think about " mechanism of injury " any further than a cursory look at a repair bill and crash photos, and they don't think about the long-term effects of prior injuries any further than that they can use one as an excuse to order an IME. I've sent dozens of them peer-reviewed science on those topics over the years, and I've explained to them the law of the State of Oregon, i.e. just because someone may have been more vulnerable to a particular injury doesn't mean that they either didn't suffer it this time, or are entitled to less treatment this time. I've never had a single substantive reply. All adjusters care about is pleasing their bosses, and pleasing their bosses means paying out an " acceptable " amount of benefits on claims of each given " type. " See #2. 6. It is true that keeping poor records and failing to regularly re-evaluate treatment in a written, detailed way will increase the odds that a) your patient will be IME'd, your charges won't be paid for by the PIP carrier, or c) your charges won't be credited by an at-fault driver's carrier when I'm negotiating your patient's settlement. Keep detailed, electronic records. Re-evaluate regularly, and put the detailed results in writing. The rest is largely out of your hands, because: 7. When in doubt, see #2. Respectfully, Ben -- Ben Attorney at Law 1205 NW 25th Avenue Portland, OR 97210 p. (503) 224-1787 f. (888) 659-7963 e. Ben@... On Jan 20, 2012, at 11:32 AM, TFreedland@... wrote: > > Dr. Medlin, > > Often there are issues that trigger an IME that you are not aware of, and this leads to the confusion you expressed. I am not saying these are the answers to your questions, but this may represent some of the factors. > > You do not mention the nature of the collision; however, you report that the patient was diagnosed with a compression fracture. Does the mechanism support this type of injury? Does the imaging show this as acute or a long standing condition? Is there any prior history of similar injuries - is he a " frequent accident " victim? Has he been truthful with you? Is there something about the accident he has not shared with you? Was there a delay in starting treatment? > > It may have nothing to do with you in particular, but there is something about the case that needs clarification. The issue may be something that cannot be shared with you, because it relates to an active investigation; this patient might be part of a bigger accident scam and you are an unwitting victim. Or the patient's name is the same as (or similar to) someone they are investigating. > > But all this is speculation. Your role is to treat the patient and provide good clinical documentation in support of your care. Contrary to popular belief, not all IMEs result in care being cut off. Although one of the biggest problems relates to poor record keeping (illegible, repetitive, contradictory, etc). > > I do not know if this helps, but there are different frames of reference to consider. > > Tom Freedland, DC > > > > > Unnecessary IME > > Posted by: " ph Medlin " spinetree@... > > Thu Jan 19, 2012 8:57 am (PST) > > > > Good morning doctors, > > There are times when I’m not surprised by an IME request. This one though has me extremely baffled. Have a patient who was in an auto accident in the beginning of October. He suffered a compression fracture of L2 to go along with a pretty nasty lumbar strain. > > Patient has been seen 12 times since the accident. A re-evaluation took place approximately 8 weeks into treatment. The exam noted vast improvements, with an estimated MMI date and included our plans as we move forward in regards to treatment/rehab. > > Our office manager called the adjuster to see if we could provide some answers that perhaps they were missing etc. and the adjuster was extremely unprofessional and rude. The state farm adjuster proceeded to tell her that it was their prerogative whether or not to send the patient to the IME and that they needed to find out if the treatment was necessary. She then proceeded to hang up on our office manager. > > We haven’t received written notice of this IME yet. The patient is requesting a change in the adjuster and will piggy back our complaints to the State of Oregon about this adjuster. > > Clinically there is NO justification for an IME. He’s only 12 visits in, and has begun re-strengthening portion of care. They contacted the patient about this after the 8th or 9th visit. > > Just wanted to share a case with you that quite clearly depicts the complete ARBITRARY manner in which these exams are ordered. It’s absolute BS! > > ph Medlin D.C. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2012 Report Share Posted January 23, 2012 Thank you for your non-DC perspective! Seitz, DC Tuality Physicians 730-D SE Oak St Hillsboro, OR 97123 (503)640-3724> CC: TFreedland@...> > From: ben@...> Date: Mon, 23 Jan 2012 13:55:03 -0800> Subject: Re: Unnecessary IME> > Not that anyone asked for a lawyer's perspective, but here's mine, based on my entire career representing crash victims and conversing daily with hundreds of other lawyers in the state doing similar work:> > 1. It's my strong suspicion that IMEs are generally ordered whenever care seems to deviate from what each insurer has decided is an acceptable, "usual" curve of treatment for a given "type" of crash. What that means in real life is that when there isn't either big vehicle damage or photos of big vehicle damage, clients won't be referred for IMEs. "Big" treatment for "small" crash = IMEs. Never mind that there is no useful predictive correlation between vehicle damage and injury a) risk, severity or c) duration in a given crash - the insurance companies don't want to hear that because:> > 2. Insurance is a business, plain and simple. Whenever the companies can plausibly/legally keep more premium dollars by paying out less on claims, they are going to do it. Little injustices compounded by millions of policyholders equal billions of dollars in savings. With my own eyes, I've seen the internal reports to back that up. > > 3. There is nothing "independent" about the IME industry. Any doctor who performs IMEs either once or for a living knows who butters their bread. They know how easy IMEs are to do, and if they are a typical human being who wants the max reward for the least work, they will know what they need to say (or more likely, cut and paste from prior reports) to keep the gravy train coming. > > While it's true that I've seen a vanishingly small number of IMEs that either a) helpfully recommended additional, but alternative treatment that helped my client or completely agreed with a primary doc's course of treatment, it's equally true that I've never seen those doctors' names on a subsequent IME report. Why do you suppose that might be? It's because the carrier wants the report it paid for - the one that says "you're all done now," or "you'll be all done in two more weeks," or (I've seen this) "you couldn't possibly be hurt because your car sustained less than $1,000 in damage."> > 4. Insurance fraud is a scarecrow, a bogeyman, used to prop up and legitimize a system whose true purpose is to limit costs whenever possible (see #2 above). Are there a handful of terrible people who attempt to manipulate the system for their own benefit? Sure. Are there some lawyers who abet such people? Sure. Those people are the 1%. The 99% are the people who suffered a legit injury in a typical crash and simply want their carrier to live up to their side of the bargain after the carrier has accepted their monthly premium payments, often for decades. > > Exaggerated accounts of the damage caused by the 1% are being used to victimize all of the rest of us when we make ordinary claims on our insurers following vehicle crashes.> > 5. Adjusters (the ones who order IMEs) don't think about "mechanism of injury" any further than a cursory look at a repair bill and crash photos, and they don't think about the long-term effects of prior injuries any further than that they can use one as an excuse to order an IME. I've sent dozens of them peer-reviewed science on those topics over the years, and I've explained to them the law of the State of Oregon, i.e. just because someone may have been more vulnerable to a particular injury doesn't mean that they either didn't suffer it this time, or are entitled to less treatment this time. I've never had a single substantive reply. > > All adjusters care about is pleasing their bosses, and pleasing their bosses means paying out an "acceptable" amount of benefits on claims of each given "type." See #2. > > 6. It is true that keeping poor records and failing to regularly re-evaluate treatment in a written, detailed way will increase the odds that a) your patient will be IME'd, your charges won't be paid for by the PIP carrier, or c) your charges won't be credited by an at-fault driver's carrier when I'm negotiating your patient's settlement. Keep detailed, electronic records. Re-evaluate regularly, and put the detailed results in writing. The rest is largely out of your hands, because:> > 7. When in doubt, see #2. > > Respectfully,> > Ben > > --> Ben > Attorney at Law> > 1205 NW 25th Avenue> Portland, OR 97210> > p. (503) 224-1787> f. (888) 659-7963> e. Ben@...> > On Jan 20, 2012, at 11:32 AM, TFreedland@... wrote:> > > > > Dr. Medlin,> > > > Often there are issues that trigger an IME that you are not aware of, and this leads to the confusion you expressed. I am not saying these are the answers to your questions, but this may represent some of the factors.> > > > You do not mention the nature of the collision; however, you report that the patient was diagnosed with a compression fracture. Does the mechanism support this type of injury? Does the imaging show this as acute or a long standing condition? Is there any prior history of similar injuries - is he a "frequent accident" victim? Has he been truthful with you? Is there something about the accident he has not shared with you? Was there a delay in starting treatment?> > > > It may have nothing to do with you in particular, but there is something about the case that needs clarification. The issue may be something that cannot be shared with you, because it relates to an active investigation; this patient might be part of a bigger accident scam and you are an unwitting victim. Or the patient's name is the same as (or similar to) someone they are investigating.> > > > But all this is speculation. Your role is to treat the patient and provide good clinical documentation in support of your care. Contrary to popular belief, not all IMEs result in care being cut off. Although one of the biggest problems relates to poor record keeping (illegible, repetitive, contradictory, etc). > > > > I do not know if this helps, but there are different frames of reference to consider.> > > > Tom Freedland, DC> > > > > > > > > > Unnecessary IME> > > > Posted by: "ph Medlin" spinetree@...> > > > Thu Jan 19, 2012 8:57 am (PST)> > > > > > > > Good morning doctors,> > > > There are times when I’m not surprised by an IME request. This one though has me extremely baffled. Have a patient who was in an auto accident in the beginning of October. He suffered a compression fracture of L2 to go along with a pretty nasty lumbar strain.> > > > Patient has been seen 12 times since the accident. A re-evaluation took place approximately 8 weeks into treatment. The exam noted vast improvements, with an estimated MMI date and included our plans as we move forward in regards to treatment/rehab.> > > > Our office manager called the adjuster to see if we could provide some answers that perhaps they were missing etc. and the adjuster was extremely unprofessional and rude. The state farm adjuster proceeded to tell her that it was their prerogative whether or not to send the patient to the IME and that they needed to find out if the treatment was necessary. She then proceeded to hang up on our office manager.> > > > We haven’t received written notice of this IME yet. The patient is requesting a change in the adjuster and will piggy back our complaints to the State of Oregon about this adjuster.> > > > Clinically there is NO justification for an IME. He’s only 12 visits in, and has begun re-strengthening portion of care. They contacted the patient about this after the 8th or 9th visit.> > > > Just wanted to share a case with you that quite clearly depicts the complete ARBITRARY manner in which these exams are ordered. It’s absolute BS!> > > > ph Medlin D.C.> > > > > > > > > > > > > > > > > > > > > ------------------------------------> > All posts must adhere to OregonDCs rules located on homepage at: /> Tell a colleague about OregonDCs! (must be licensed Oregon DC) Quote Link to comment Share on other sites More sharing options...
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