Injured workers who seek remedy through the appellate process often find themselves at odds with “independent medical examiners,” explains a recent report by NBC.
Although the report focuses mainly on cases from the Bay Area of California, this issue is applicable nationally, including here in Georgia. As our Atlanta workers’ compensation attorneys often need to explain, “independent” medical examiners aren’t exactly “independent.” These health care professionals are often on contract with the employer (or the insurance company) and have a vested interest in keeping the employer/insurer happy in order to retain these lucrative contracts. Claimants are sometimes required to undergo an independent medical exam as part of their case.
In the NBC analysis, reporters noted that updated procedures in California require injured workers denied benefits to have their case reviewed by a state-contracted, for-profit company. These “Independent Medical Reviews” involve payment to anonymous doctors who never actually examine the patient one-on-one and who determine eligibility based on specific standard guidelines. The news report indicated that between 2013 and 2015, injured workers contested some 600,000 denials of medical treatment following a work-related injury. Of those, 90 percent of denials were upheld following an appeal to the independent medical review. Continue reading →