Medical Examiners: Whose Side Are They On?

It is unavoidable that workers get injured on the job or acquire certain occupational diseases. When this happens, workers are entitled to workers’ compensation, wherein the insurance covers medical expenses during the temporary or permanent impairment.

In such instances, doctors and medical practitioners are employed to assess the physical condition of the workers. Their reports would serve as medical proof, which could determine whether or not the worker would be able to avail of the benefits. The professional medical examiner can be retained by the claimant or the employer or insurance company.

There have been cases all throughout the country where the examiner retained by the insurer has favored the insurance company, so that the company won’t have to pay for the compensation. On the other hand, there are also instances where the examiner exaggerates the claimant’s medical results to ensure that he or she avails of the benefits. Medical examiners, regardless of whether they are provided by the claimant or the insurer, are prone to certain financial and professional bias.

In order to understand the medical examiner bias in the context of a personal-injury claim, we should examine how and why such biases occur.
Worker’s Treating Physician’s Bias

Workers have an option to choose and provide their own medical examiner in the context of compensation claims. After an initial consultation, the physician could claim that there is indeed an injury, regardless of whether there really is one or not. By accepting the worker’s declaration of injury, it would be financially beneficial to the doctor to provide treatment over a certain period of time. Moreover, family doctors have the tendency to be biased towards his or her patient, and would most probably accept or believe the patient’s complaint, even in the absence of any pathology. This is because refusing to treat or contradicting the patient would drive him or her to look for and consult a different physician.

The (Not-So) Independent Medical Examiner

In the case that a treating physician retained by the claimant states the occurrence of an injury that could be a basis for claiming the benefit, insurance companies or the employer have an option to request for an additional examination. They would provide an Independent Medical Examiner (IME) that could either ensure or dispute the legitimacy of the claim. Although most IMEs are qualified and are assumed to be objective and fair, there is still a possibility that some are biased against the worker or claimant. These IMEs would favor the defendant or the insurance company, mainly to maintain a certain “partnership” where the doctor would continuously receive referrals from the insurer. The supposedly independent medical examiner would report that there is no apparent injury regardless if whether there is one or not.  When this happens, the insurer does not have to compensate for the worker’s claim.

Given these biases, disputes relating to treatment and medical providers invariably occur. To avoid these situations, it is best to seek legal advice from a Denver workers compensation attorney. In the context of work-injury claims, the Denver workers compensation lawyer will make sure that the worker would get the proper treatment and unbiased medical examination that he or she deserves.

Contact Kaplan Morrell to discuss your workers compensation claim in the Greeley and Denver areas. For over 15 years, experienced workers compensation and disability attorneys have been successfully helping workers in Colorado claim what is due them.