“Plaintiff IME Part 2 of 3”
WARNING: If you have not read all previous consultations, then you stand the chance of being a “one-and-done” with the lawyers. You have to learn to speak their language of admissibility.
For decades, the defense industry has used Independent Medical Examinations (IME’s) as a way to, in theory, get a third party to render an opinion as to the true nature of the patient’s condition. The truth however, is another story. As every doctor in the personal injury industry knows, the purpose of the IME is to terminate care and limit the liability of the insurance company.
For 25 years, in various practices, I have read 1000’s of IME reports and the vast majority of them are a work of fiction. The IME doctors fail to report x-rays and MRI films and reports that have been placed in their hands; they omit the patient’s accounting of specialists seen and reports rendered. Worst of all, the insurers that hires these doctors virtually never forward any test results in their possession. This also includes the 7 page IME report with a 2 minute IME doctor encounter, where the doctor never touched the patient. The results are a grossly incomplete examination, with no records in hand, no matter how readily available. With that said, there are a few honest IME’s that will be accurate in their assessment. Again, in my 25 year experience, they are far and few between.
Personally, I worked for an IME company for 1 week. I evaluated 2 patients and rendered a fair report after spending 45 minutes with each patient. I was fired because I refused to change my findings and recommendations from damage to the nerve root, and twice per week for 6-8 weeks to strain/sprain and 2 more visits in total. I was told that if I did as they asked, they had another 100 patients per month to send me. Needless to say, I never worked for them again. Unfortunately, there are many that did. I can relate numerous personal IME experiences both as a patient and doctor; I am sure all of you can as well. Now that we have defined the state of the IME system, let’s turn lemons into lemonade!
Each of you should become IME doctors. Not to the insurance industry, but to the patients and the lawyers representing those patients. This is called the Plaintiff IME. A concept so simple it will revolutionize the industry and hopefully allow the truth regarding the patient’s condition to be documented and accepted into the courts for the patients to get a fair hearing or settlement.
A Plaintiff IME is called the “second opinion” or a consultation. It is in the CPT-9 code book as 99243-4-5, depending on the level of Evaluation and Management (E&M code) you are performing on the patient. I performed a level 99245 on my patients, as I spent a significant amount of time with the patient and documented accordingly. A 99245 (for argument sake) is a code used when you are not treating the patient and are evaluating them as a specialist or for a second opinion. With this code, a narrative in the format as I have suggested over the last 16 consultations, should be rendered.
What will happen is that the legal representative of the patient will now have 2 IME’s; one at the request of the insurance company and one at the request of the patient. With these, it should level the playing field of the findings, should there be clinical findings suggestive of pathology as a result of the injury. It is the legal right of every patient in the country to seek a second opinion.
When speaking to attorneys, either over the phone or preferably during your breakfast meeting, explain to them the Plaintiff IME. Ask them, “Do you know what a Plaintiff IME is?” All will say no because it doesn’t yet exist. You are on the cutting edge of changing the industry. Educate them as to what you can do for their clients and further explain that you will render a report, if clinically indicated, integrating their patient’s functional loss with bodily damage.
When doing the Plaintiff IME, you want the patient referred prior to the Insurance IME, so that benefits are intact and you do not have to lien, arbitrate or litigate for your fees in No-Fault states. In every state, you can simply charge a fee and you will get paid up front for your time and report. Most orthopedists and neurologists charge $800-$1000 for a report that is 1-2 pages long, utilizes strain/sprain in the diagnosis and does not reflect functional loss. I have historically charged $500 for the report and rarely has it been questioned. In fact, the majority of the attorneys I have dealt with pay up front for the report, glad to level the playing field with the Insurance IME. I was doing 4-5 Plaintiff IME’s per week for many years.
In other areas of the country, I have released this concept and the results are similar to what I experienced. It is a great way to create a relationship with lawyers and a great reason to have breakfast. When you educate the legal community about the Plaintiff IME, you will start to get their clients for second opinions. Over time, should you deliver admissible paperwork, they will then start to send you the rest of their clients because you will have set a standard that very few in the industry can meet.