IME Physician Statements in DCBS IME Survey
(Replies were annonymous which improved honesty. Fifty-three percent of respondents admitted that examiners are biased in favor of insurers.)
IME physician survey, question 14. Please list three ideas for how to better prepare injured workers for IMEs? (selected survey answers listed)
Tell patient to videotape the entire exam and interview (or record it). Bring a witness
More consideration of the injured worker
Make certain examiner fully qualified to evaluate workers problems. If IME opinion differs from treating physician, provide worker reasonable options. Recommend patient advocate or relative attend IME
Don't do IMEs hired by the insurance co - they are not truly "independent"
Explain purpose of IME. Explain that it is being held so the Insurer can deny the claim
1. IME should be truly independent, many workers have had multiple evaluations sponsored by an insurance company in order to get the opinion they want.
IME physician survey, question 21. WCD has received complaints that IME doctors are considered biased toward insurers, what is your response to this complaint? (all survey answers listed)
This is probably true. The majority of evaluations have an insurer bias. The IME, especially psychiatric IME's, have NEVER suggested treatment issues but only how to close the claim, to blame the patient, with little understanding of realistic pain management treatment approaches. The Psychiatric IMEs are done by professionals who have no experience with pain, do not treat pain patients, and only look to finding psychopathology, rather than how to provide treatment that will be realistically helpful to the patient and insurer.
1. Doctors have biases, just like other folks.
2. Physicians who own IME facilities and/or whose income depends largely on the IME business often seem to have a bias towards the insurer because they believe it will assure them of more business.
3. Insurers say they want IME reports that will stand up at a hearing... I believe that is probably true most of the time.
4. A worker's physician has the opportunity to comment on the IME report, which offsets the bias.
5. Worker's physicians are biased towards the workers. I have heard physicians say that if a worker believes that he/she has had an injury, that is sufficient for the physician to agree with and support the claim.
6. Physicians don't want to be put in the position of opposing their patient's belief in the validity of a claim... hence their bias towards the worker.
I'm sure some of them are. I try to be as neutral and objective as possible, but if there is a 50-50 situation, I will generally favor the patient.
The majority of IME doctors either make their whole living or a good portion of their living from IME's. They know not to bite the hand that feeds them. That is why most reports conclusion is that there was a pre-existing condition that accounts for just over 51% of the reason for the problem.
Explain to each patient at outset that all opinions will be based only on medical facts that I could explain to them.
I approach each exam objectively. I try to be fair to all parties. I call each one as I see it.
There is no question that the vast majority of IME Drs are obviously and blatantly biased for the defense
Definitely yes. Especially those who rely solely on IME for their income. Practicing MD's give much better quality reports- more balanced
We are not advocator for the patient as in his/her treating physician. I do not consider alternative health care services
Look up / review my exams and see for yourself whether I'm fair. Also , what about all the patients hurt/ injured by doctors "bending" legitimate indications for treatment / surgery in order to make a buck?
I think there are some like that ( Claimants, patients lawyers and insurance companies are biased, too!)
I am not biased
I try to be independent. If insurer doesn't like my opinion, go down the street to another MD
Everyone is biased in some way. The Respiratory system permits very conjecture measurements if functioning with imaging studies that permits sticking to the facts
Whoever pays the bills would naturally tend to receive a bias
In my 13 years of practice IME doctors have consistently supported resolution of the patient complaints - my be 1/100 support the patients condition of pain continuing subsequent to their injury.
in some cases that is true
I am sure this occurs. IME doctors need to be specialists in the part being examined not nerve conduction specialists or other periphery related specialists
Not so, I provide an unbiased opinion regarding the patient. I consider this in the best interest of the patient. Sometimes the party sending the patient doesn't like the opinion.
Agree, some physicians perform IMEs for their livelihood. If that is all they do, I don't see they could be balanced
I try to be a objective as possible about one third of the time I find in favor of the claimant
I think so
some maybe - I'm not independent as what I believe I am
there may be some truth to this if a persons practice is only based upon one type of evaluation and referral source for workers compensation claims, but this is not always true - There are many IME doctors who give objective opinions based upon data from the exam and give them unbiased opinions
I understand - I try to "call them as I see them"
This is just not true. We only see the most contentious cases and even of those 30-35% we agree with the claimant, Just because the claimant doesn't like the report doesn't mean the facts didn't support it.
I disagree. I think it is natural for someone whose claim is denied to feel that the "system" is working against them
it is understandable considering the adversary process
Not so in my case. Also do independent exams for both plaintiff and defense cases per atty. requests about 50% each. Have reputation for being "fair"
I treat all patients equally with similar problems
I don't believe that I am. Probably the larger % of a practice a doctor has in IME, the more potential for bias (insurer's become the source of income)
I see myself as a medical consultant and provide opinions - letting chips fall where they may. Sometimes find medical issues not addressed , issue reports
This is difficult to refute as most IMEs are requested by insurers. Claimants often appear to lack knowledge of differences between objective and subjective findings.
I don't do enough of them to know about that
Often true I have seen cases after an IME Dr (retired only income is IMEs) The report is often biased by this type of Dr.
I'm not- but I agree some are very biased and I don't know how they reach their conclusions
Some IME evaluators do appear biased just as some attending MD's appear biased the other way. I try to stay as "middle of the road" as possible
I believe that is true in some cases I explain who I am - private practice- and my intention to be unbiased. I explain the process and the purpose of IME
I tend to agree with that to some extent
I calls 'em as I see 'em". I'm sure I've rattled a few cages" But I do believe some panel members I have been with are biased this way and sometimes their examinations are either cursory or misinterpreted.
My experience would indicate that some are, not all.
I try to be as objective as possible feeling if my opinion helps or hurts an insurer or a claimant that is their problem. They often don't understand the "major" contributing cause, principle.
Its to be fair
Some MDs become jaded by their experience with patients on workers comp. or disability and do become biased. I try to stay impartial
If the shoe fits put it on
I would ask treating Doctor to point out flaws in my conclusion based on exam findings and chart documentation
Insurers chose physicians with known biases to "?" IMES
I agree, I have seen a number of IME reports over the years by certain doctors who clearly are not "worker friendly"
true because the insurer picks the doctor (this is true whether the IME company tells you this or not)
The population sample is skewed by the severity of injury, outcomes, pain behavior or secondary gain issues
don't care about insurers, only the medical facts
I think that might be true
They are not
Many times - yes/ Also toward worker.
I think it may be true, especially w/panel IMEs (or any other situation) w/ MDs who only do IME or where IMEs are a major part of their practice
Yes, I know 2 or 3 are so blatant its shameful
I think this is true for some examiner most examiners that I "?" with try to be fair and unbiased
My goal is an unbiased opinion I don't have to IMEs financially and I do not work for insurance companies
I'm not surprised. Sometimes the way the questions are worded demonstrates the bias of the insurer. Also certain Doctors only do IMEs / or it may seem like it and those Doctors seem to always have the same opinion. Patients talk to each other and they get a of whether a doctor is an "insurance" doctor or a clinician. In my opinion insurers who only use a narrow set of doctors for IMEs are setting themselves up for a battle with the patients attorney. Using a doctor who is not on the routine list of IME doctors could help the insurer gain another viewpoint and clearly would help them gain a few points with the patients attorney. Or better yet ask the attending physician for some ideas, if the attending gets some input into the IME process they Ins will be less argumentative with the results. Sometimes the insurer , because they are not doctors, choose the wrong specialty to perform the IME. For example a patient with a sodium problem due to a brain injury should see an endocrinologist, not a nephrologist. The attending can help with this. My biggest frustration is being last to know. If the patient trusts me, which I hope is the case and if they trust the insurer, then it makes the insurer look devious when the patient tells me that they have an IME next week and I know nothing. It seems like the attending and the insurer should have a better working relationship. I know that some doctors seem to disagree with what ever the insurer wants but I have to believe they are in the minority. Some of the rest of us are getting more like that as we, are kept in the dark and our knowledge is not respected. Sorry, this is so negative. I am not one of the problematic doctors, but I see the negativity in the system. Thank you
Treating physician can disagree and suggest appeal through the system
Doctors are biased toward restoring duration, which usually means getting back to work. Delay in recovery is seen as resistance of worker to "get over it", instead of suggesting a more severe injury
I do not believe I am / "?" but cannot speak for other doctors
There are doctors " "no" and "yes" and some are independent
I feel many examiners are biased toward insurers because of the reports I get "?" from IMEs with unreasonable conclusions
I cannot speak for other physicians who perform IME's. My personal response is that while I do IME's and recognize that the insurer pays the bill, the majority of my clinical and surgical practice is not associated with IME's. I do not rely on IME's to be an important economic part of my business. I believe it is important to be independent and objective in my examination and impression.
unfounded. Its the nature of the patient to be skeptical and distrusting in this situation. Disclosure of no conflict of interest doesn't seem to help I believe its the lawyers that propagate this myth
I try to demonstrate no biases
some are, some are not
I feel I am not
no biased observed
Biased professionals indeed would be a problem. Personally, I do not see myself as biased and I tell patient that I am to be fair. Base findings of objective test results.
Almost invariably IME are biased toward insurance carriers, in my opinion
WC patients are biased against insurers leading to the impression that any opinion that sides with the insurer is automatically biased against them. This bias is due to the fact that patients are not free of bias.
the workers feel that way as we are not their Dr
Valid opinion. The vast majority of insurance companies arrange and pay for IMEs. If a physician wants IME business, he/she must bias report accordingly
It is for the most part completely true. There are some rare exceptions. The IME physicians know who is hiring them, knows who is paying
IME MDs are in my experience very objective and a lot less bias than the treating physicians.
I agree this is common. But the requirement that conclusions are to based only on "objective evidence" lends itself to this. Subjective symptoms carry less weight than in clinical practice.
There are some reports which seen to bear out this complaint, where the patient's symptoms and physical findings are minimized or omitted from the final impressions, or where acute findings are categorized as "pre-existing" or "degenerative".
I would agree that MDs where sole livelihood is a great "?" of their income is for IMEs are biased
Insurance companies select the physicians whose answers are consistent with their own physicians so in general they are biased in their philosophy, but don't necessarily say something only because they know that's what the insurance co wants to hear
I hope I'm impartial
Most all doctors I know are very objective
I do not believe I am biased toward insurers
I think that is often true
Bound to happen since the exam is initiated by the insurer which makes the patient referred IME doctor as a "company doctor"
I'm neutral. Opinions based upon data. I have also worked with worker attorney
This is not correct. IME doctors see only about 10-15% of the entire injures w/c population. These people are sent in because they so not fit the common sense injury: recovery model. If the IME opinion counters their agenda - then the process is labeled "biased" irrespective of the medical facts. Why not audit the Bias charts? It would be easy to pick out an unfair exam- Which is not based on current science
It is not our money, so I see no reason for Bias. Claimants would be expected to complain. Everyone even neighbors want their way
Some IME docs maybe but not myself
The physicians with whom I work all try to be neutral. Many of my reports have been more helpful to the worker than the ins co
Insurers are familiar with the practices of physicians and tend to close physicians that are likely support their position. Attorneys are also familiar with physicians practices and tend to chose those that support their positions.
Some are and some insurers (particularly Liberty) seem to select based on that.
I very much agree.
They are. I make a conscious effort not to be, but it does take conscious effort.
Everyone has a potential bias. The IME doctor is "independent" of treating the patient, makes no $ by treating the patient, is not an advocate for one patient (as a treating physician is) and is therefore less biased than the treating physician.
I am not biased one way or another. The report I have read have been objective.
I am a patient advocate but believe I report fairly.
I have read many such (?) reports. The physicians have rude statements such as "all indirect hernias are congenital" as a basis for denying a claim.
I have none that I'm aware of but hear it regularly.
The state not the insurer chooses me to do the IME. The insurer has no way to influence me.
Generally accurate impression. Don't bit the hand that feeds us.
As a practicing physician I believe it is overwhelmingly true. I try to be fair in my own and I believe the tide is turning
I do not work for insurers
Some are paid for opinions
Claimant attorneys foster that belief, though there is probably some truth for some examiners. For most part, treating MDs, therapists, are definitely biased toward what claimants describe as truth.
Sometimes they are. I only do IMEs through a third party agency. They pay me for the IME, not the insurance company.
Many seem to be. It is our experience that insurers select doctors who are knowledgeable about workers comp rules and who will provide an opinion based upon those criteria.
Some of them seem to intimate that I always tell them I am here "to tell it like it is". If my reports help them (the company) or hurts them, it's not my problem.
I have found for the patient 50% of the time
Some are, but the primary reason for that complaint is a lack of understanding as to what constitutes a work related injury.
IME doctors are no more biased toward insurers than treating physicians are biased toward their patients. An IME doctor has the opportunity to be more objective than the treating physician.
I think this is to some degree true, but I make every effort to proved an unbiased opinion.
Treating physicians are sympathetic toward patients but IME doctors are neutral. This may be seen as being pro-insurer.
I think many are
There is absolutely no doubt about this bias. Insurers pick doctors to do IMEs that are biased. As physicians, we know this and discuss people by name.
I think my record shows that I'm not.
My impression as well.
I know many who are clearly biased and unethical. But the majority are fair.
Of course they are going to get complaints. The patients have a much higher expectation of their disability than they really are.
I certainly am not.
It is my understanding that worker is to be given benefit of doubt. I try very hard not be biased, but some of the questions seemed designed to get an answer that will seem biased.
I agree that many are. The insurers are also aware of which are/are not.
I answer to the best of my ability. I have to be able to defend my position
IME physician survey, question 23. What are the three main misconceptions about IMD doctors and exams? (all survey answers listed)
That they are unbiased. Most providers know that if an IME professional does not side with the insurer that they will not receive additional referrals for evaluations. A misconception is that they are "independent" when in fact this is only because they don't directly work for the insurer. However, IME's are focused on insurer bias with a focus on the patient as the manipulator of the system rather than one who has been injured.
I believe the data to answer this question would best be obtained from a survey of workers. I don't have insight into this question.
That IME MD's are "insurance doctors."
That they are competent and their opinion actually helps the patient
Plaintiffs are too biased re: honest IME's
Patients feel IME docs are "working for" insurance co. confusion between SAIF and WCD
We are Insurance doctors
We are "hired guns"
We are "medical whores"
They are fair
They are diligent
They are unbiased
insurers hired guns (not necessarily a misconception).
rough examinations (not necessarily a misconception).
Incomplete and short
I have no idea - why not ask the patients?
Many think all are "claim closers"
Many treating Doctors get angry about the IME process, but sometimes I feel its due to their poor work up etc
We work for Insurer
We are biased "?"
We are not honest
"?" for insurer
always "favor" one side
That they are "agents" of the Insurance Co.- untrue
That they are always find in favor of the Insurance Co.-Untrue
At times the worker thinks he/she will get treatment or advise - not true
All are fair and well informed
All are unfair and work for Insurance companies
The doctors are "agents" of the insurance company
that the IME decides when a claim is closed
The attending physician must agree w/the report
Some people don't realize they are sometimes needed!
That all IME doctors are biased
IME doctors don't really examine the claimant
The IME doctors who are often retired from active practice don't understand currant medical practices
All examining physicians lean to the insurance companies
They wont give a fair exam
They work for the insurance company
that they work for the Ins. Co.
They did not listen
That we work for insurance companies
That we are biased
That we cause them pain even though they are told never to cause themselves pain and no passive exam is done
that they are supposed to treat the patients
that they work for the insurance companies
too short of exams
All are "hired guns"
Examiner will "hurt me"
IME Drs not in "Active" practice are outdated, actually opposite is true. We evaluate multiple patients /multiple variety of problems we are up to rate as are made aware of what is being done and what works in different Drs hands. Must keep up to date to review cases for court testimony, etc
not involved in treating patients
incompetent and/or uncaring
Haven't got any experience about this
Bias - see no 21
that IME doctors are "hired guns"
that IME doctors cannot form valid opinions based on a single examination
They are fixed
Opinions are made prior to exam
They are all "for" the insurance company
Most IME doctors do primarily or only IMEs not in practice
IME are primarily to absolve insurers of responsibility
All IMEs are biased
Cloak and Dagger
Living in the shadows
That they are independent
That we are "employed by the insurance company"
That we are not sympathetic or understanding of their problems
That our policy is not offering opinion recommendations for their treatment means an incomplete evaluation.
They are employees of the insurer.
Their reports are biased toward the insurer
In Oregon, they don't understand major contributing cause
The IME MDs work for the insurance company
The IME MD will oppose the patients disability
Insurance companies are dishonest
Doctors are dishonest
Patients are dishonest
That I work for an Insurance Co
That I report biased information that favors insurance
That I never report favorably supporting examiners complaints or treating doctor
they are fair
they are non biased
they are there for the worker
They are biased against workers
They are biased agents of insurers
their opinions are for sale
That the docs work for the ins co
That the docs care about how the exam comes out
that they are the bottom of the barrel in terms of expertise
ex alcoholics who cant get work anywhere else
lazy, don't keep up with changing standards of care
That they are biased toward Ins Co
That work for Insurance Company
That work for Employer
That are paid good - to go against worker
Biased against worker
Couldn't make it in "private" practice
Getting near retirement
they will treat the patient
they can give advice
All work for Ins company
All Bias against worker - Willing to distort , misinterpret facts
MD in it only for money
Most "?" and out of "?" in current practice
Insufficient time spent
That the Doctor works solely for the insurance company
That the exam will only help the insurer and hurt the patient
That the whole process is adversarial
"Gonna take away my disability"
Company doc or hired detective
get paid to represent company in "?"
That there is a bias
That we work for the insurance company
That we are paid for one opinion rather than our time
Have not done enough to know of any
1. Many build a practice strictly around IME's. With the exception of some neurologists and orthopedists, I believe most IME doctors have a small volume of IME business, and do it as a "paid public service" for the benefit of workers and insurers.
2. Contrary to what many workers think when they come for the exam, the IME physician is not there to minimize their disability findings, or prove they don't have a problem. Our role is to independently verify their attending physician's findings and recommendations.
3. It's a misconception to think any docs are getting wealthy providing these exams.
Employment by insurance co. perception
Patient as a commodity perception
Lack of sympathy perception
Docs should be a neutral party
We follow strict guidelines in assessment of disability
Recommendations based on objective findings as much as possible
The IME is seeking to disapprove the findings of the attending physician
That IMEs are "independent"
That IMEs are authoritative
That IMEs are based upon state of the are concepts / information
Drs are biased to worker and insurance companies and are not "?'
The exams are independent and unbiased
The exams are performed by experts
Insurance not independent in many cases
That they are independent
That they are unbiased
That they are fair
Most are retired MDs they are often not up on current technology, they tend to be the "just say no" going
They are not objective and independent
They are not objective and independent
They are not objective and independent
They are truly "independent" (Ins companies Do request specific doctors!)
They are not subject to bias.
They are willfully indifferent to claimants subjective suffering.
They are all same
They are fair
They are unbiased
They have the workers best interest in mind
Most Doctors dislike malingerers
I think that patients often think they'll get advice
Patients often think its a "done deal" and decisions are already made
The patient can get medical advice from the IME doctor
The IME doctor is adversarial
The IME doctor is biased
That the exam is painful - in fact usually the only valid comprehensive exam in the file
That the doctors will be mean
I have no idea. Ask Gallup.com If you want a good poll
That we are Hatchetmen for the Insurers.
Patients don't always know we have their old records and frequently are not candid about prior injuries or tests.
Patients sometimes feel we are there to consult with them not just as examiners
They are biased.
They work for the insurer.
They make decision with cursory reviews.
It is a truly independent exam.
Over-reaching (their expertise).
But all are probably true!!
That they are unbiased.
That patients can refuse parts of exam.
That arbitration exams are the IMEs ( they are very different).
The doctors work "for" the insurance company.
A retired physician is at a disadvantage in evaluating a claim.
It is all a plot to "screw" the injured worker.
They are independent.
They are "experts."
Decision making/recommendation and documentation of all three.
They are fair. They are impartial. They are factually based on sound medical principles.
Treating doctors. "Company" doctors. Incompetent doctors.
Insurer advocate bias
1. All IME docs have same credentials 2. IME will "get to bottom" of problem 3. Panel exams are "better" than individual exams
That purpose of exam is to disallow benefits.
1. IME doctors are bias toward the insurer and against patient's rights. 2. The IME doctor only sees the patient one time, therefore is not able to assess the patients' status.
1. They are for the benefit of the employer not them
2. We are going to tell them our diagnosis, and tell them what treatment they need
3. We work for the employer or insurance company
1. That they are in insurers pocket
2. That they are inferior doctors
They are working for the insurance company.
1. That they work for the insurance companies.
2. That they are not compassionate.
3. That they do not have the same training or experience as the examinee's own physician.
1. They work for the insurance company
2. They are biased
3. They do not do adequate exam.
1. They report what insurers want to hear.
1. That they are fair and unbiased
2. That exams are useful. At least 50% of IMEs patients undergo are a waste of money.
3. They are scheduled by the insurance company not at my request and often blatantly appear to be the companies' attempt to alter or terminate care to save money.
2. They are actively practicing.
3. They are specialists in the field of medicine which applies.
They are biased and work for the insurance company
1. That we work for the insurance company (Note Company is also paying their treating doctor).
2. That we will be biased.
all biased one way, work for insurance/defense side always
IME physician survey, question 24. What major changes have you seen in the IME system in the past 10 years? (most revealing answers listed)
They have become even more focused on cutting off treatment. More IME's focus their practice on doing IME's. These are not treating professionals who work with patients on a regular basis. They are professionals who devote a large part of what they do to doing IME's.
Many Doctors do IMEs that have minimal expertise in the area they are examining
more likely to have an IME to deny claim, not to resolve an issue
More IME's are being done by facilities or by physician who do not also maintain private practices. Some of the "opinions" seem very biased and focus on explaining symptoms in terms of degeneration or other non-traumatic causes rather than providing a true second opinion.
Seemingly canned reports. Some facilities generate excessive, non-helpful transcribed information.
IME physician survey, question 25. What improvements to the IME process would you recommend? (most revealing answers listed)
Weed out the doctors who are not providing impartial opinions but merely being "yes men" for the insurance companies. This is the majority of them starting with Anthony Woodward.
Have them not be paid by insurance companies
Should be done by practicing MD although few practicing MD would do exams
less physicians who only do IMEs (its bias)
Develop a pool of providers selected by the profession at large and provide a random rotation of reviewers
Hold IME Doctors liable for their reports and conclusions
Abolish current system
Stop IME mills from doing the majority of IME exams
Attorney/worker should be allowed to chose examiner or have exclusion of certain examiners
Require IME evaluation to have at least 50% practice treating patient.
Remove Dr. from the panel that clearly show consistent bias - we all know who they are but I doubt many Dr. stick their neck out to identify them. Make sure they are done by Drs who have active practices and therefore they know the other side of the process.
Paid by independent source. All exams recorded and available for review by attorneys.
Hold IME docs to evidence based on scientific data
I believe there is at least one IME facility which slants its results toward the insurance company. Business should be steered away from that facility.
IME physician survey, question 26. Please share any other comments you have about IMEs. (selected survey answers listed)
I think that IME Drs should be monitored by looking at how often ALJ's opine against them, and if they are shown to be too biased, eliminate them from the IME pool. Insurers place money on each patient into a pool initially (e.g. enough to typically cover 3 IME's) and then if the money is not used refund it to the insurer. But the state sends the patient to the IME, not the insurer, and therefore the examining doctor is not beholden to the insurer for his livelihood, made like the an arbiter system now in place. A patient should simply be made to go to any doctor he/she wishes after an IME gives a negative appraisal at the expense of the insurer and be able to do so similarly offer each IME for the defense.
I call IME - "Insurance Medical Exams - paid by ins company, they are clearly biased towards resolving the claim - denying the patients claim
Insurance companies over use IMEs, It would be more economical to just pay the medical claim for a recent injury
The current system is biased against the injured worker who too often ends up on the public dole. This could be prevented by developing an efficient medical diagnosis and management system.
Arbitration's are intrusively more fault. The one who pays the bills (insurer) calls the shots with IME. My unbiased approach has caused my IME business to dwindle (I sometimes find that the patient is right - for it is not so black & white). The same honesty has gotten me as many arbiter exams as I can handle (there pay far less). An IME has to be done for the good of the whole, being fair to insurer, patient, employer, society, etc (i.e., W/C system, etc.)
They used to be independent; they no longer are.
The system often times seems biased against legitimate claims. I understand that there are many who try to scam the system, but there seem to be too many honest claims that are...denied - seemingly for financial reasons.
Current system is a biased joke. I've had an adjuster tell me if I didn't say such and such they'd just send the patient for IME with Dr. "X" because he's say it. A certain number of doctors make a significant amount of there income from IMEs. They say what the insurer wants as they get more IMEs and they make more money. This current system is totally flawed.