DCBS: IME Study - Some Statistics

The modus operandi of these exams is to defeat the claim. Learn how to prepare for one. See evidence of bias and fraud. Read the revealing state-conducted IME study.

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DCBS: IME Study - Some Statistics

Postby Webmaster » February 25th, 2005, 8:27 pm

Department of Consumer and Business Services
Insurer Medical Examination Study

Presented to:
Workers' Compensation Management-Labor Advisory Committee

The state study/survey, released on December 2, 2004, has confirmed what injured workers have reported for years.

The 271-page report is nothing short of a wholesale indictment of IME's. Even 53 percent of IME practitioners admited they're biased against workers. Replies were annonymous which improved honesty on their part.

The IME practioners formed a political committee and are spreading contributions around the legislature. Please come forward with your IME experiences so we can counter their efforts. Also, contact your state senator and representative.

When time is available, we'll separate pages so it's not one large file. This requires the free Abobe Acrobat Reader at

http://www.cbs.state.or.us/external/wcd ... udyrpt.pdf or http://www.injuredworker.org/imestudyrpt.pdf

The following is an excerpt from the Division's 12/2/04 report to MLAC on the study.

The committee had been given information on anecdotal complaints about IME doctors and the IME process. We developed questions in the surveys to address these complaints, which were: IME doctor bias towards insurers, IME doctors mistreating injured workers, IME doctors not viewing the actual diagnostic studies, injured workers having to travel quite far to attend IMEs, injured workers not being adequately informed on what to expect at an IME, and that insurers attempted to influence IME doctor’s medical reports.

Our findings from the study, validate all of these areas of concern.

Since our charge was to gather information on what the IME system in Oregon looks like, each survey had additional questions in order to paint an accurate picture.

Some statistics:
• The number of claims with one or more reported IMEs has been slowly rising, from 6,373 in 2000 to 7,045 in 2003.
• The number of reported IMEs per payment year increased from 8,747 in 2000 to 10,423 in 2002; in 2003 the number of claims with IMEs was 9,677.The average payment for the reported IMEs in 2003 was $637.
• In the first quarter of 2002, IMEs were the third highest medical service according to total payments.
• Total cost of IMEs is over $6 million a year.

IME claims, as compared to non-IME claims, were:
• 8 times as likely to have a claim disposition agreement (settlement of an accepted claim).
•15 times as likely to have a disputed claim settlement (settlement of a denied claim).

More statistics can be found in the back of the report under “general statistics.”

Significant highlights from the surveys and focus groups include:

Injured workers
• 21% of injured workers traveled more than 100 miles one way to their IME.
• 23% had difficulties covering their travel expenses.
• 35% of the respondents report that the insurer explained to them what to expect at the IME, of these 63 percent were satisfied to very satisfied with the explanation.
• 60% of the respondents stated they were dissatisfied to very dissatisfied with their IME.
• 34% responded they saw their attending physician after the IME due to re-injury or increased levels of pain.
• 55% said they did not see a copy of their IME report.

Attending physicians
• 32% of attending physicians stated they felt pressured by an insurer to concur with an IME report.
• Only 23% always review the IME report with their patient.
• 75% have received complaints from the patients regarding their IME experience

In asking how to improve the IME system, 41% responded that the IMEs need to be unbiased.

Claimant attorneys
•74% rated their clients’ experience with IMEs as poor.
The 3 greatest concerns were bias (48%), lack of practicing doctors performing IMEs (7%), and IME reports not accurately reflecting what occurred in the exam (7%)
When asked what they did to prepare their clients for an IME, 21% explained the process and claimant’s rights, 20% instructed them to be truthful, 13% explained the exam is biased, 7% instructed them not to exaggerate their symptoms, and 7% instructed them to be cooperative.
Most frequent suggestions for improvement were: doctors should have an active practice, a process similar to the Medical Arbiter program should be used, find a way to make the IME physicians objective, get rid of the process entirely, and limit the number of IMEs.

Defense attorneys
• 56% felt insurers moderately prepare injured workers on what to expect in an IME, 22% said injured workers were slightly prepared, 15% said they are very prepared, 7% said they are not prepared at all.

In asking about shortcomings of the process, 20% said: no consequences when workers fail to attend an exam, 16% said the exam is biased toward the insurer, 11% said doctors do not receive adequate records and 20% indicated there were no shortcomings.

The top suggestions for improving the IME process were: 23% said injured workers should pay for no shows, 18% said “it is fine as it is,” 11% said to educate physicians on the process, 7% said find a way to make the exams impartial, 7% said to provide better information to workers, and 7% said get more doctors to participate.

IME physicians
• 85% maintained a private practice, 65% also served as attending physicians seeing an average of 50 workers comp patients a year.
• 22% contracted with insurance companies, including one who said they had a contractual agreement with a guaranteed minimum of IME referrals.
• 82% would allow a worker’s representative into the exam and 61% would allow the exam to be recorded.
• 9% said they would often consult with the claims examiner before drafting the IME report. 44% said they never consult with a claims examiner prior to the report.
• 21% reported that an insurer representative has attempted to influence their IME report.

When asked about insurer bias of IME doctors, 53% said there is bias.

Suggestions for improvement: 29% said “have more physicians with private practices to limit their reliance on insurer IMEs, and randomly select IME physicians.19% said to get accurate and up-to-date medical records and scans to the IME doctors, and 9% said there should be more accountability upon IME physicians and to create standards and require feedback.
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