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  1. #21
    Join Date
    Dec 2008
    Posts
    4

    Default Re: IME, MMI - with Objective Findings Saying Otherwise

    Thanks for the info on the fraud unit. However, I am thinking of something that would benefits all of us. We know that its hard to sue a IME because he's not the treating physician but in my opinion he is because the insurance company weigh heavily on his opinion. That being said, as I mention in my earlier post, we need to look for an attorney that would take a class action case such as ours. Because it is more that one person that claims our our IME medical reports are fasified by the same IME physician. I am and will continue to seek legal action. Not only are these insurance company's denying benefits and payments, they are causing us to have permanent physical diabilities. I believe if each of us do our homework and find an attorney, than we can post the information of the attorney and all meet in his/her office to look over our medical reports. I suggest everyone get all of their medical records from your treating physicians as well as the IME report from your wc insurance carrier so we can be ready when we find someone.

    Right now, there is a lawsuit against Allstate and State Farm insurance companies for Sham Exams. This is what we are going thru except ours is WC.

    WC does not pay for pain and suffering. And they are getting away with providing medical treatment as well as paying us. This is not something that should be allowed but it is and its time something is done about it.

    My suggestion is to find an attorney that would take a case action suit that would include all of us. If that is not possible, than I suggest that we go on nation TV and put the spot light on them so this can be checked out.

    As for me, I believe we can find an attorney that will take a case such as ours and I will continue to search until I find him.

    Oh and I forgot to mention for those waiting to continue medical treatments, trying working with your private healthcare and find out if they would allow you to continue your medical treatments. Advise them that you were injured on the job. This can be done if you have a letter from your insurance carrier saying that you will receive no further benefits.

    Let me know your thoughts on the above.
    Regards.

  2. #22
    Join Date
    Aug 2007
    Posts
    504

    Default Re: IME, MMI - with Objective Findings Saying Otherwise

    Letsfightback

    I really don't want to rain on your parade, but it is not the IME that has final say so as to what benefits are approve or denied. That decision is in the hands of the WC arbitraitor. It is up to the IW or their legal representation to take disputes to the WC arbitraitor for the decision.

    An IME, be it this infamous *Dr G*, or any IME DR. will evaluate a pt's medical records the way they see fit. There is nothing illegal when one Dr evaluates differently than another. I had two IMEs. One of them said I was not a candidate for surgery and the other said I may need surgery in the future. They both are entitled to their opinions and neither broke any laws by what they said.

    As far as WC not paying for pain and suffering..... That along with being able to sue one's employer were traded off years ago. In order to assure approved medical and TTD is paid for in a timely manner by the IC the ability to sue one's employer and to be paid for pain and suffering were given up. I know it wasn't our choice but it is what it is.

    If you seriously want to pursue this then you might want to run your idea by PI attornies. They don't require a retainer and will basically be paid from any award that is given. If you can't get a PI attorney to take the case then there probably isn't much of a payout if any down the road.

    I'm curious. What is your current situation? You said you had back surgery. Has your case been settled? Do you have an attorney? Where you given a PPD rating? Have you gone to pre-trial? Are you looking to go to trial to keep your medical open?

    beachgirl

  3. #23
    Join Date
    Dec 2008
    Posts
    4

    Angry Re: IME, MMI - with Objective Findings Saying Otherwise

    Beachgirl thank you for your reply. But please don't get ahead of yourself thinking you can rain on my parade because that is not possible. I am well aware that an IME dr. doesn't make the final decision on WC cases but if the insurance carrier he works for relies on his opinion, than yes, your benefits can be terminated based on his opinion.

    As for the opinions of an IME doctor, no one is saying that they broke the law for their opinions, but when the opinion of these IME doctors are falsifying medical records of claimants to deny medical treatment, then they are breaking the law which is insurance fraud if the claimant has not reached MMI. They are being deceptive not to include medical evident of the underlying condition of the claimant that would otherwise consider the claimant as disabled, regardless if its a temporary or permanent disability.

    I am not aware of how you were treated by your wc carrier other than you having two IME exams. When you have walked in my shoes or some of the others that were mistreated by our wc carriers as far as not getting proper medical treatment and have to continue suffering until our attorneys can have our medical treatments approved, than you should tip toe and not TRY TO RAIN ON other's parade. Some of us are permanently disable due to the opinion of IME's medical reports.

    I am well aware of the tradeoff of wc laws of not being able to sue the employer directly, but we are not talking about suing the employer. The employer is already being sued if you have a wc case. I clearly stated "suing the IME doctor". By all means, that would include the insurance carrier(s) that he works for.

    And I am serious about my pursue in obtaining another attorney other than my wc attorney. And I'm going to find one.

    To satify your curiosity, I have a wc case pending and am disabled because of an IME doctor denying and prolonging my medical treatment.

    Regards.
    Letsfightback

  4. #24
    Join Date
    Dec 2008
    Posts
    24

    Default Re: IME, MMI - with Objective Findings Saying Otherwise

    I'd like to be clear as to what I'm talking about: I am not talking about drawing different conclusions from diagnostics and a perfunctory evaluation - right, Beachgirl, though I think we all know it's a load of crap, the doctor can likely, rightfully, say "I don't see what anyone else is seeing here," can utterly dismiss the conclusions drawn from diagnostic and treating physicians entirely, and because an IME isn't "treating," there aren't any grounds for malpractice. It's the symptom in place.

    What a physician cannot do is literally and intentionally lie as to what did or did not take place during the IME. For instance, reporting that a patient gave a (false) positive indication of pain on a test designed to show malingering, when that patient did nothing of the kind; falsely saying the patient displayed "inconsistent" symptoms (i.e., "walked/extended/flexed normally one second," and "bizarrely, didn't another," etc.) throughout the examination, and so forth, all in an attempt to bolster a false claim of "symptom magnification" - when it's completely false. It's falsifying a report, and it is fraud. And if there can be found evidence that the physician was in essence instructed as to what the carrier was looking for, such that they committed the falsehoods at the instruction of the company paying him or her, that's collusive fraud. And it's a fact that this fraud hurts people, badly, and should be dealt with by the appropriate channels.

    Edited to add: Posted before seeing Lets's reply. I agree with him here - it's about falsifying facts, not conclusions drawn, however unjust those conclusions are by any reasonable standard of care. It's a loophole that because the IME isn't treating, their "opinion" is essentially untouchable (to any legal action). But literally falsifying reports, or colluding with a carrier to make false reports, well, I am pretty well convinced this is another thing.

    Let's, I did contact a law firm, as I mentioned, but they weren't interested. I was encouraged by my WC counsel to contact the fraud unit I earlier provided, and I personally think this is the best route to go. Because there isn't any malpractice, from what I know of law firms, they just won't give a damn because the potential ROI for fraud is so much less than an obvious malpractice, even if it's a class action. That said, I would encourage anyone believing they've had a report made with false facts to report away. But be mindful that the IME will come to know you've filed a claim, and you will have to testify. In my case, I am fully prepared to report the truth.
    Last edited by Blownbackster; 01-02-2009 at 09:54 PM.

  5. #25
    Join Date
    Aug 2007
    Posts
    504

    Default Re: IME, MMI - with Objective Findings Saying Otherwise

    Quote Quoting Letsfightback View Post
    Beachgirl thank you for your reply. But please don't get ahead of yourself thinking you can rain on my parade because that is not possible. I am well aware that an IME dr. doesn't make the final decision on WC cases but if the insurance carrier he works for relies on his opinion, than yes, your benefits can be terminated based on his opinion.

    As for the opinions of an IME doctor, no one is saying that they broke the law for their opinions, but when the opinion of these IME doctors are falsifying medical records of claimants to deny medical treatment, then they are breaking the law which is insurance fraud if the claimant has not reached MMI. They are being deceptive not to include medical evident of the underlying condition of the claimant that would otherwise consider the claimant as disabled, regardless if its a temporary or permanent disability.

    I am not aware of how you were treated by your wc carrier other than you having two IME exams. When you have walked in my shoes or some of the others that were mistreated by our wc carriers as far as not getting proper medical treatment and have to continue suffering until our attorneys can have our medical treatments approved, than you should tip toe and not TRY TO RAIN ON other's parade. Some of us are permanently disable due to the opinion of IME's medical reports.

    I am well aware of the tradeoff of wc laws of not being able to sue the employer directly, but we are not talking about suing the employer. The employer is already being sued if you have a wc case. I clearly stated "suing the IME doctor". By all means, that would include the insurance carrier(s) that he works for.

    And I am serious about my pursue in obtaining another attorney other than my wc attorney. And I'm going to find one.

    To satify your curiosity, I have a wc case pending and am disabled because of an IME doctor denying and prolonging my medical treatment.

    Regards.
    Letsfightback
    I wish you the best of luck finding an attorney that will take your case. I spoke to the PI law practice that refered me to the WC attorney that represented me in my WC case, about your interest in representation. They are not interested. I asked them if they could recommend an attorney ( there are referal fees for attornies when they refer) and they knew of no one in the greater Chicagoland area that they felt it would be worth even mentioning it to. There are thousands of attornies in Illinois and the firm I spoke to doesn't know them all, so hopefully you'll find one that is interested.

    I'm sory to hear there were delays in you receiving medical treatment, that have led you to your current status.

    I do have an additional question for you. Why did it take so long to get your medical treatment approved? I am assuming your attorney filed a 19b as soon as the IC denied treatment based on an IME that contradicted your PTP's treatment plan.

    I know when the IC in my case tried to deny me tests and proceedures my attorney was all over them. My attorney made sure all tests and proceedures my DR ordered were done. The IC that we had to deal with was no walk in the park. They tried just about everything possible to deny and delay, including having me followed and video tapped.

    Besides getting all my tests and proceedures approved he also had the IC supply me with at home care for over a month after my injury, transporation to and from all medical appts before I was released to drive, had an IME cancelled when he felt the IME the appt was with was an insurance co. hack, and he also got me the highest % of PPD for my type on injury ever awarded in the state of Illinois. My experience with the IC and WC would have been much worse if I hadn't had a very talented attorney. I thank God evey day that I had him on my side.

    beachgirl

  6. #26
    Join Date
    Aug 2007
    Posts
    504

    Default Re: IME, MMI - with Objective Findings Saying Otherwise

    Quote Quoting Blownbackster View Post
    I'd like to be clear as to what I'm talking about: I am not talking about drawing different conclusions from diagnostics and a perfunctory evaluation - right, Beachgirl, though I think we all know it's a load of crap, the doctor can likely, rightfully, say "I don't see what anyone else is seeing here," can utterly dismiss the conclusions drawn from diagnostic and treating physicians entirely, and because an IME isn't "treating," there aren't any grounds for malpractice. It's the symptom in place.

    What a physician cannot do is literally and intentionally lie as to what did or did not take place during the IME. For instance, reporting that a patient gave a (false) positive indication of pain on a test designed to show malingering, when that patient did nothing of the kind; falsely saying the patient displayed "inconsistent" symptoms (i.e., "walked/extended/flexed normally one second," and "bizarrely, didn't another," etc.) throughout the examination, and so forth, all in an attempt to bolster a false claim of "symptom magnification" - when it's completely false. It's falsifying a report, and it is fraud. And if there can be found evidence that the physician was in essence instructed as to what the carrier was looking for, such that they committed the falsehoods at the instruction of the company paying him or her, that's collusive fraud. And it's a fact that this fraud hurts people, badly, and should be dealt with by the appropriate channels.

    Edited to add: Posted before seeing Lets's reply. I agree with him here - it's about falsifying facts, not conclusions drawn, however unjust those conclusions are by any reasonable standard of care. It's a loophole that because the IME isn't treating, their "opinion" is essentially untouchable (to any legal action). But literally falsifying reports, or colluding with a carrier to make false reports, well, I am pretty well convinced this is another thing.

    Let's, I did contact a law firm, as I mentioned, but they weren't interested. I was encouraged by my WC counsel to contact the fraud unit I earlier provided, and I personally think this is the best route to go. Because there isn't any malpractice, from what I know of law firms, they just won't give a damn because the potential ROI for fraud is so much less than an obvious malpractice, even if it's a class action. That said, I would encourage anyone believing they've had a report made with false facts to report away. But be mindful that the IME will come to know you've filed a claim, and you will have to testify. In my case, I am fully prepared to report the truth.
    I don't know if this will help you or not, but when I went to the first IME and was checking in at the desk, I saw a letter that the IC had sent to the IME that was sitting on top of my file. The receptionist was a nice young gal and I simply asked her to make a copy of the letter so I could have it in my records since the file they had on me was about me. She agreed. As she was handing me the letter another older woman walked up and asked the young gal to step into the back. My appt was at 10am and this all tranpired at 9:45am . I ended up sitting and waiting until 2pm to be seen. The young gal that made me a copy of letter never returned to the front desk. I have to think that the reason I had to wait is that I was given the letter and the IME's office had to do a last minute huddle with the IC. The letter was filled with lies about me and my condition. It also was a thinly vieled attempt to *guide* the IME's findings. So the reason I bring this up to you is there could very well be one of these types of letters in your IME's records on you. Perhaps it would help your fraud pursuit to go to the IME's office and have them show you your file and if there is a letter in it like the one I got demand they make you a copy. Of course you may already know of one and have it already. Just thought I'd share the info incase you don't.

    beachgirl

  7. #27
    Join Date
    Dec 2008
    Posts
    24

    Default Re: IME, MMI - with Objective Findings Saying Otherwise

    Want to bump this thread, as I heard back from the WC fraud unit. Here is what they said to do.

    Anyone here, or anywhere, who has experienced the kind of fraud I allege was committed by this physician, please contact the fraud unit and file a request for investigation. Without it, doctors like this will continue to be allowed to act with impunity, and it is only by taking action that we can put an end to the pattern of abuse, by at least one physician.

    By fraud, I am talking about a situation like mine - where a doctor literally falsified a report, falsified facts, and not the conclusions drawn from the data coming in, or from their evaluation - that is a separate issue, one of "reasonableness" and "standard of care."

    In other words, by fraud, and falsifying facts, I am saying something like when the IME reports "patient screamed "OW!" when I asked him to give his name - and this is a classic sign of symptom magnification." Or, in my case, lying about my indicating pain on certain manipulations, when I did nothing of the kind, and numerous other instances of falsifying facts.

    I was also advised to file a complaint with the Department of Professional Regulation. The website is here.

    In my complaint with the Department of Professional Regulations, I have alleged fraudulent falsifying of facts. I also requested the Department to investigate his findings, based on the objective data he used to draw his conclusions. As I understand it, a team of doctors will look at the same data, and if it seems the IME doctor's report is at some threshold out of sync with a "reasonable" conclusion based on facts, it trips a switch.

    I am not all that hopeful a team of doctors will in essence indict one of their own; but it's all we have, apparently, within the law.

    I contend that this doctor is hurting many people, who have acted in good faith. It's very important that if you've been hurt in this way, you file a complaint with both:

    1. The Illinois Workers' Compensation Fraud investigation unit.

    Mr. Francis (Buzz) Walsh
    Unit Supervisor

    Illinois Dept. of Financial
    and Professional Regulation,
    Division of Insurance
    Workers' Compensation Fraud Unit
    100 W Randolph St., Suite 9-301
    Chicago, IL 60601
    312-636-9457
    217-557-8463 (Fax)

    francis.walsh@illinois.gov

    2. The Illinois Department of Professional Regulations.

    Any questions, anyone, please feel free to contact me. I am not out for a blood lynching; I am out to put an end to at least one unconscionable pattern of bad faith.

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