Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 1103
Office Systems 98 OS

From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

"What is the process for rebutting an improper IME?"

 

Dr Studin: Do you do IME and peer review, correct?

Guest Doctor: Yes, Right!

Dr Studin: Doctors still don't fully understand the full benefit of what you do and how hard it is that you do. And a lot of people think they can write these things. I just had a call from someone in California where USAA, which seems to be the largest aggressor in the country, said based upon their doctor, their Chiro is that 100% of the care was necessary in a paper review. They said the doctor quoted many research articles, guidelines. All the guideline that's set on a population-based study and if you're a carrier, the guideline will say x. If you're a provider, you're going to go with a guideline that says y. And I'm saying all that matters is your last clinical examination. That's all that matters. So, I said to him, did the peer review doctor quote your positive funding? He says, no, he just said based upon the patient's symptoms and ignored my findings. So how would you attack that?

Guest Doctor: First of all, out of the guidelines they are using our theological studies and not clinical studies so that according from the wrong sources. The other thing is that most of the doctors that do IMEs they lie by omission, all 50 states in the country have a law stating that the IME is responsible for an accurate and complete diagnosis. So many times what they'll do is they'll list, for example, an MRI finding, as one of the reviews that I had done, one of the information that they looked at, but they will list it a diagnosis. For example, if you have a herniation, they'll continue to use sprain strain diagnosis. Well, based on the information that they provided they are lying, because they're omitting the diagnosis herniation.

Dr Studin: What about a clinical finding or mission?

Guest Doctor: A positive orthopedic finding?

Dr Studin: Yes.

Guest Doctor: A lot of times they'll leave it out or not include it or they'll state it wasn't complete. So in other words, they lie about it.

Dr Studin: What is the action of the treating doctor at that point in time based upon your suggests, not your recommendation, that's a suggestion. Doctor has to choose what they want. But what do you suggest?

Guest Doctor: I would suggest that they indicate what they found. The IME doc left it out and include that in their report along with a very important thing here is that they violated a state law or state regulation. And you have to go into each state and see which regulation that they violated and apply it as such.

Dr Studin: If you feel that the peer review or IME doctor committed a violation, what do you suggest the doctor do?

Guest Doctor: Quilt violation from the state statute.

Dr Studin: And if you want do what with it ?

Guest Doctor: Indicate that they're lying on it or they're violating state statute.

Dr Studin: You're writing in your report to the insurance company that's a committed a violation or what else are you doing?

Guest Doctor: They did convicted violations against state statute, They didn't include all the information and they're wrong. And the reason is in the medical literature, why they're wrong and also the state statute to back it up.

Dr Studin: Do you also recommend a render a complaint against their license?

Guest Doctor: Absolutely.

Dr Studin: What percentage of reports do you find it is filled by omission?

Guest Doctor: I'd say at least 90% being generous.

Dr Studin: These reports are not easy to write and how to take a lie, a doctor who lies by omission and then really you're judge and jury at that point in time, laying your argument that why if it's the statute or the law, which is a statute or the regulation that flies in the face and stature the regulation, you have to write a good report about that. So that works. Hopefully a lot of doctors will understand that they can do it themselves, but it's a waste of their time.

Guest Doctor: It's not easy talking about three to six hours to do a report. And he has to do with very dispassionately laid out lie by lie. 

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