Michael J. Walker: Importance of IME’s? Give me a break!

As a practicing workers’ compensation attorney in Spokane for 30 years, I am compelled to respond to the Feb. 28 Guest Opinion (“Senate bill recognizes importance of IMEs”) submitted by Dr. Craig Smith (Seattle IME examiner) and Kris Tefft (Olympia attorney for Washington Self-Insurers Association).

SSB 6440 is nothing more than big business’s attempt to avoid legislation designed to help clean up a biased and broken “IME” system. Rather than making real, necessary changes, the substitute bill delays by punting the issue to a “task force.” Action is needed, not more meetings.

Let’s be honest. The term Independent Medical Examination (“IME”) is a euphemistic moniker by insurance defense interests to lend legitimacy to a high volume, highly biased, niche medical industry designed to benefit insurance companies and state agencies, not injured workers. In our practice, these exams are referred to as “Defense Medical Examinations.” I will spare the readers the term typically used to describe IME examiners.

Nothing about these exams is “independent.” To make the Department of Labor & Industries’ “approved” list, examiners must undergo training by the department, not an outside agency or independent medical association group. The department mandates compliance with its own instruction manual, controls submission of medical records/documents, generates pre-exam written instructions describing the facts/issues (oftentimes inaccurately), and limits the examiners from commenting on any conditions other than those referenced. Injured workers are not allowed to submit written input, either before or after the IME, despite having the most to lose.

If the department or self-insured employer is dissatisfied with the IME, addendum reports are sought until the opinions they seek are provided. If the treating physician disagrees with the IME, the defense schedules repeat IMEs, so benefits can be denied based on “preponderance” of medical opinion.

IME examiners are under contract with the department, not injured workers. Public disclosure documents confirm there are “approved” examiners making $500,000 to $1 million annually performing these exams. One need only follow the money to recognize opinions will ultimately favor those who hire the examiners. A truly “independent” exam would be by a physician without financial motivation.

Anyone who has undergone an IME quickly recognizes the examiner is not there to help. Extensive complaints have been filed over the cursory nature of IMEs. It’s a cattle call, often with the same examiner doing 10-15 exams per day. How can one perform an unbiased exam lasting less than 10 minutes? When an examiner cuts off an injured worker attempting to describe symptoms or correct an inaccurate history of injury, how can it be truly independent? The sole purpose of an IME is not to get at the truth, but to provide a medical opinion necessary to support denial of benefits.

The Hippocratic Oath requires physicians to “do no harm.” If only IME examiners followed this rule, the system would be different. Dr. Smith and Mr. Tefft are silent on the thousands of workers across the state devastated by IMEs. They prevent injured workers from securing treatment ordered by doctors and specialists (from physical therapy, to diagnostic MRIs, to injections, to spinal surgery). IMEs routinely conclude treatment is not necessary, not related, or due to a pre-existing condition. Anything to avoid payment of proper and necessary treatment ultimately designed to return the injured worker to the active labor force.

We need commonsense changes to the IME system. They should be in close proximity to the injured worker, rather than hundreds of miles away. Out-of-state examiners (e.g., Florida and Texas) need to make themselves available locally to defend their opinions. Audio/video taping of the exams should be permitted, and representatives allowed to observe. The number of IMEs should be limited to avoid abuse. In sum, workers’ compensation IME rules should mirror those used for private insurers in all other kinds of injury cases. Such practical changes are necessary and fair. The defense industries don’t want fair.

The workers’ compensation system was designed to provide sure and certain relief to injured workers. IMEs result in increased delays, increased litigation, and unnecessary cost to injured workers who can least afford it. We need to re-establish a proper balance that is fair to injured workers.

Michael J. Walker is a claimants’ attorney with Delay, Curran, Thompson, Pontarolo & Walker, P.S.