The One Sided Truth About "Independent" Medical Evaluations

12 March 2014
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12 March 2014, Comments: Comments Off on The One Sided Truth About “Independent” Medical Evaluations

Imagine allowing a physician, who you have no previous relationship with to inspect and gather medical evidence against you and you have no opportunity to view it. This sounds pretty invasive, right? Well, that is the gist of an independent medical evaluation. Essentially, these independent medical evaluations are conducted by “disinterested” physicians, on behalf of insurance companies, who make important recommendations about the validity of a claimant’s injuries for either Workers Compensation or No-Fault Insurance benefits.

In a recent Michigan Court of Appeals decision, Jennifer Paul v. Glendale Neurological Associates, PC, the court addressed the question of whether a workers compensation claimant has a right to obtain copies of their independent medical evaluation. In this case, the claimant, (an injured worker) underwent an evaluation. During the evaluation, the physician performed an MRI and other diagnostic tests.  Following the exam, Ms. Paul requested a copy of the records and reports from her insurance company. The company refused to provide a copy of the records, claiming that she was not entitled to this information due to the fact that she was only being evaluated (and not receiving medical care) by their physician.

Incredibly, the Court of Appeals sided with the insurance company and denied the worker her “medical records.” Although devoid of any sound legal reasoning, the court found that the purpose of an independent medical evaluation is to “gather information for a third-party in related financial decisions.” Thus, the court determined that the reports do not constitute medical records as they are not generated “in the course of caring for a patient.” As a result of this absurd ruling, a claimant is afforded no opportunity to question any discrepancies made by the evaluating physician to their insurance company.

Realistically, these medical evaluations are inherently grounded in unfairness because the insurance companies make the request for the claimant to see a physician of their choosing. Moreover, these physicians are cued into what factors the insurance company are looking for, such that it can tip the scales more favorably to their case. More often than not, the insurance company provides generous compensation for these medical evaluators and their “expert opinion.” While the scope of the evaluation is limited to general appearance and manifestations of injury, perhaps the courts, in fairness, should reconsider access to these evaluations to level the playing field.

By: Fahd Haque, Law Clerk for Moss & Colella, P.C. If you have any questions, email: Fahd Haque at FHaque@mosscolella.com