IME's (Independent Medical Exams)

I was referred to an IME, after my doctor told me that I needed another surgery. This is a Workman's Comp case.
What has been your experiences with IME's? I do not believe in this tactic at all by insurance companies. Because all this doctor did was meet me for 25-30 min., took notes, looked at my knee and moved it around a bit, told me to walk across the room and then took measurements. His findings are what bugs me the most. After looking at an MRI, he does not believe I need further treatment. To basically, do home exercises and "live with the pain". I don't even think he is knowledgeable in knee surgery. Workman's Comp just sends me to some unknown doctor that doesn't even live in my State and I'm supposed to take his word over the word of my doctor and the radiologist?! So Workman's Comp is basically wiping their hands of it now. But I went back to my doctor and got his opinion on what is the best option. And he said I need surgery now before it gets worse when I'm older. If Workman's Comp denies this surgery, I told them that I will have to seek counsel. No word from Workman's Comp yet. But in your experience, do they eventually give in and say ok on the surgery? How long should I give them to decide yes or no? It's been 2 days now, on pain meds until I get the green light. I'm not looking to get money, I just want my knee fixed. Bottom line, it's not fixed yet, this is still related to my accident and then having to go through multiple surgeries and I'm still in pain. I want it taken care of. Any info that you can give me on this would be a huge help. Thanks.

In regards to to the above

In regards to to the above situation, it would be an orthopedic surgeon performing this assessment. I should note that a radiologist is only able to report what they see on the screen; they do not take a history or examine patients. The surgeon puts the pieces of the puzzle together, and sometimes ( frequently ) surgery is not indicated.

From your screen name it seems like you are young ( i.e. mid 30s ) ; have you have had a meniscal or ACL repair in the past ? Or was your previous surgery a joint replacement ?

If the surgeon thought surgery would help your condition I am pretty sure he would've said so.

If your family Dr. thinks that surgery would really help, they should get a second opinion.

chrisaldridge wrote: If the

chrisaldridge wrote:

If the surgeon thought surgery would help your condition I am pretty sure he would've said so.

I'm pretty sure it's possible that your "IME" may not know his ass from a hole in the ground.

I'm pretty sure that it's possible that your "IME" may not care about your health and well-being.

I'm pretty sure that IMEs (just like Medical Expert Opinion Providers working for the CMPA) get paid by their clients, whether or not their opinion is professional and evidence based. You are not their client and they don't need to care about you.

I'm pretty sure that if they save Workman's Compensation money, they will be hired again and again.

However, Chris probably knows more about this than I do. But I'm pretty sure that Chris is biased towards doctors and thinks that I am crazy.

All aboard the train to Nuttyville! Eye-wink

I've been a passenger since 2004. Stare

wishandaprayer

wishandaprayer wrote:
chrisaldridge wrote:

If the surgeon thought surgery would help your condition I am pretty sure he would've said so.

I'm pretty sure it's possible that your "IME" may not know his ass from a hole in the ground.

I'm pretty sure that it's possible that your "IME" may not care about your health and well-being.

I'm pretty sure that IMEs (just like Medical Expert Opinion Providers working for the CMPA) get paid by their clients, whether or not their opinion is professional and evidence based. You are not their client and they don't need to care about you.

I'm pretty sure that if they save Workman's Compensation money, they will be hired again and again.

However, Chris probably knows more about this than I do. But I'm pretty sure that Chris is biased towards doctors and thinks that I am crazy.

All aboard the train to Nuttyville! Eye-wink

I've been a passenger since 2004. Stare

The above does not make sense and here's why:

I have performed independent medical evaluations for the past 8 years, and simply stating your opinion is insufficient grounds for refusing surgery, a requested treatment plan, etc.

The evaluating physician is required to provide a detailed medical explanation as to why it is their clinical opinion that surgery is or is not indicated ( for example, as in the above case ).

Moreover, as the above case is in the realm of workers compensation: if surgery is truly indicated ( i.e. would help ) I fail to see why workers compensation would not pay for it. Specifically, if this intervention would allow the worker to return to work, this would not only decrease this person's suffering, and increase their function, it would also allow for discontinuation of illness benefits.

What is the motivation here for an independent evaluator to deny such a claim ?

An independent medical expert

An independent medical expert may, in fact, NOT be a qualified expert - at least in Ontario.

For example, in Ontario - they may have had many very valid complaints about them, but have been very well protected by the CMPA and very inadequate investigations.

From my understanding, in Ontario, the IME does not owe any "duty of care" towards the person that they are providing an opinion for. As a doctor, you supposedly owe your patients a "duty of care", but when acting as an IME, there is no such duty.

Correct me if I'm wrong Chris.

What is the difference between IMEs and Medical Expert Opinion Providers? Please explain. You are both out to make money, and if the CMPA does not care if the opinion is ethical and professional, why would Workman's Compensation?

Just for clarification - my husband says that I'm on the road back from Nuttyville. Eye-wink

A doctor is asked to provide

A doctor is asked to provide an independent expert opinion for just that reason: they are a recognized expert in their field of study.

On the other hand, the college does receive a number of complaints every year on IMEs. Does this mean that the doctor who performed this evaluation was not an expert or was biased etc.?

No it does not. Frequently these evaluations ask questions that have a significant impact to the person being evaluated ( i.e. sick benefits , insurance / work disability, etc. ). It is not surprising that someone would complain about a physician who was at least partly responsible for having their benefits terminated.

In respect to the fact independent examiners do not have a doctor-patient relationship with the examinees: that is correct. This is important in order to avoid bias. This is a good reason why the patient's family physician should not be performing such assessments on their own patients: they would be unable to do so as they are biased, having known the patient for a significant period of time ( and developed a doctor-patient relationship.)

I have performed a significant amount of work for workers compensation. It is very important to this organization that workers are treated in an ethical and caring manner. Of significant note is the fact that should a worker be injured on the job, this organization will go to significant lengths to retrain this individual. It is quite impressive.

Isn't it true that some IMEs

Isn't it true that some IMEs forte may simply be nothing more than RHETORIC? Puzzled Smiling

I got that word in an e-mail. You can call me crazy, but I think it was divine inspiration.

I looked up the meaning.

http://dictionary.reference.com/browse/rhetoric?s=t

World English Dictionary

rhetoric (ˈrɛtərɪk)

— n
1. the study of the technique of using language effectively

2. the art of using speech to persuade, influence, or please; oratory

3. excessive use of ornamentation and contrivance in spoken or written discourse; bombast

4. speech or discourse that pretends to significance but lacks true meaning: all the politician says is mere rhetoric

[C14: via Latin from Greek rhētorikē ( tekhnē ) (the art of) rhetoric, from rhētōr rhetor ]

Collins English Dictionary - Complete & Unabridged 10th Edition
2009 © William Collins Sons & Co. Ltd. 1979, 1986 © HarperCollins
Publishers 1998, 2000, 2003, 2005, 2006, 2007, 2009
Cite This Source

Workers Comp works like this;

Workers Comp works like this; due everything possible to deny diagnosis treatment so no money is spent out of the fund; Containment of costs, through denial of medical testing;
Canadian Government is in on this also; Universal Health Care is a big lie;

BOLD FACED LIARS; Duh I did

BOLD FACED LIARS;
Duh I did not fall of the turnip truck yesterday, it has been over 8 years since work injury;
5 ortho surgeons - 3 neurosurgeons = NO PHYSICAL EXAMINATION , no mri or ct scan;
how is this even possible in this day and age?
results no diagnosis - no treatment = severe intractable pain;
denied claim file information submitted to quasi-judicial appeal tribunal, x3
got a lawyer got some claim file information, found falsified medical reports submitted by doctors;
found even more lies and purposely placed inaccurate info;
found reports filled wiith lies were submitted by doctors to workers compensation that never ever happened;
last year; sent MRI to 2nd opion radiologist; USA - results;
multiple spinal injuries missed by canadian radiologists;
last week new info;
doctor didn't even have scan arranged of injured body part but reported nothing to see;
workers comp is
MEDICAL LEGAL INSURANCE FRAUD / RACKETEERING;
TRUST NO ONE;
GET 2ND OPINS FOR EVERYTHING;

Total BS in Canada; IME

Total BS in Canada; IME examinations are used to terminate benefits, even if the injured worker needs surgery. been there seen it!

Wait- why would "cutting off

Wait- why would "cutting off treatment" be an issue in Canada where you can get whatever care you need?
That doesn't make sense

So 8 doctors are all

So 8 doctors are all "lying"?
Maybe you can just find out what's wrong on your own?
Why does treatment need to go trough workers comp?
If you are in Canada isn't it covered?
Why even have workers comp in Canada?

JLittleone wrote: So 8

JLittleone wrote:

So 8 doctors are all "lying"?
Maybe you can just find out what's wrong on your own?
Why does treatment need to go trough workers comp?
If you are in Canada isn't it covered?
Why even have workers comp in Canada?

The federal-provincial shared cost universal health care programs do not award *compensation* to employees for their injuries, nor does it provide a living allowance during recuperation.

Workers Compensation in Canada is a provincial responsibility, and the cost is not shared with the federal government.

In Canada; if / after,

In Canada; if / after, suffering a work injury; Government legislation discriminates the injured worker, (should be medical patient) from receiving any medical care, services from provincial (state) Universal health Care which is paid from everyone's taxes, whether you like it or not;

As workers compensation is entirely funded by employers who pay anywhere from $2 per hundred of employee wages, to whatever compensation considers just;

When I was injured my employer paid $1.80 per hundred; I earned $6700 per month so my employer paid 67 x $1.80 = $120.60

As workers comp charges almost everyone, who works, (there are very few employment categories which are not covered;)

By Government Law; when you go to hospital or doctor, there is a sign at every doctors office, telling you; to report to your doctor this is a work injury, (this is done so billing for services is paid by workers compensation;)

Our Health care system is overburdened and BROKE; Health Care rationing is at an epidemic;
(after waiting 1 year for a cortisone shot) the doctor lied and stated I didnot report for injection;) This was purposely done after I caught the doctor in another lie;

In my case, 4 doctors opinion I have a mal-union, un-united coccyx fracture;
However the radiologist states it is debatable...?
workers comp has debated this for over 8 years even though recently medical tourism states;
Only chance for health recovery is operation called coccygectomy; as I have an old coccyx fracture which healed mal-union, due to denial after denial of medical care;

Coccyx injuries (Tailbone injuries) can be unbelievably debilitating, severe pain flares, occur when trying to sit; a condition call coccydynia or coccygodynia can develop which is stated to cause pain as a pinched nerve or worse; after reading a workers compensation appeal recently I discovered an injured worker with tailbone injury who had; bone scan, MRI's, CT scan, X-rays,nerve blocks, etc. etc. etc;

All these tests could not properly identify the injured workers cause of severe tailbone pain; after 2.5 years, an operation was finally done, and the surgeon found;
#1. grossly hypermobile tailbone which fractured through the cartilage, and caused extensive scarring, the surgeon stated the operation should have been done earlier as this injured worker
is now completely disabled due to severe pain, which resulted due to scarring of his internals;

Even though the pain was worsening, and causing further injury, workers compensation states, the operation should not have been done as it did not allow return to work;

As workers compensation states they don't pay for pain, only disability, loss of function, impairment, they considered the surgery unnecessary;

Workers compensation in Canada is a bunch of psychopathic corporate *****

Can you imagine, being in severe pain, when trying to walk, sit, stand, lay or trying to have a bowel movement, yet surgery is denied;

Workers Compensation in Canada is as I call it;

WCB = Medical Legal Insurance Fraud / Racketeering

here below is what a judge in Alberta Canada said about workers compensation;

" It cannot be said that the Board is independent insofar as the worker is concerned. It is a Board set up to protect the employers. The Board is funded by the employers, and the Board has a duty and probably a primary duty to protect the employer. In relation to the worker, the Board has an overwhelming wealth of knowledge and experience. It has the financial ability to fund sophisticated investigations involving highly qualified experts and have the material presented to them, guided, orchestrated and propounded by its in-house counsel responsible to the Board and paid for by the Board. The application of any standards under the rules of natural justice would identify such circumstances as being unequal in negotiating ability and unfair. This is not a level playing field, it is not fair, and it offends the basic principles of natural justice."
- Justice Maclean - Court of Queen's Bench of Alberta
Wilson v. Medicine Hat (City) [1999] A. J. No. 269 (February 3, 1999)

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here is my poem;
________________

Here I lay with a shattered spine,

Denied diagnosis / treatment for the 100th time,

1 doctor, 2 doctors, 3 and then 4, my specific complaints all ignored,

1 Hospital, 2 Hospitals, 3 and then 4, are there any real doctors around here anymore,

My request for MRI, to diagnose the injury, the reason for pain,

Is met with denial and denial again,

3 years pass in the blink of an eye,

No CT scan or MRI;

Finally in pain an MRI is ordered,

but not for spine,

just for my shoulder,

the ortho surgeon requests funds 4 surgery

but this is denied by WCB. (workers compensation board)

I am told once the surgery for shoulder is done,

My back pain will disappear, it will be gone,

Then I’m labelled a malingering faker behind my back,

From a doctor whose obviously a boneheaded quack:

I beg for help as I’m in severe pain,

but bottles and bottles of pills, are given again,

a new doctor states he’s already been warned,

so no tests are ordered, and I’m shown the door:

Another assessment paid by WCB,

4 doctors opinion just more physiotherapy,

I’m given exercises and stretches to due,

A Psych evaluation comes out of the blue:

In physiotherapy my back starts to spasm,

electric shocks and pain you cannot fathom,

a new doctor orders a x-ray at last,

and diagnoses my broken back:

Then a MRI is finally given,

followed by a retired neurosurgeon for opinion,

10 recommendations he made for rehabilitation,

Denied everything with WCB legislation:

My injury claim closed, benefits terminated,

Multiple complaints of severe pain not investigated.

3 more years pass in the blink of an eye,

my specific complaints are all denied:

At last, I receive a physical examination,

My complaint of pain is investigated,

Oh here is the problem, which was missed,

another spinal injury, the doctor insists:

That’s 3 years ago, when I finally received,

a proper diagnosis of my work injury,

But here I lay with a shattered spine,

denied medical care by WCB every time;

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