In my daily scouring of the web for all things related to no-fault insurance — aided of course by Google Alerts – I came across this post by Steven Gursten over at the Michigan Auto Lawyer Blog. I’m reposting it here because I think it is compelling; and whether you agree with the post or not, the author’s passion and conviction is admirable.
How Insurance Company IME Doctors Are Ruining Michigan’s No-Fault Insurance System
August 17th, 2010
No-Fault insurance lawyer explains how “independent” medical examiners devastate lives after serious car accidents and undermine our No-Fault system
When people suffer personal injury in car accidents in Michigan, their auto insurance companies must pay No-Fault insurance benefits for all auto accident-related medical treatment that’s reasonably necessary for the injured person’s recovery and rehabilitation. By simply filing an application for No-Fault insurance benefits within one year of the car accident date with their own No-Fault insurers, auto accident victims are provided with legally mandated No-Fault insurance so they can try to heal and put their lives back together.
That is, until typically between three to six months passes and that auto insurance company claims adjuster decides to send that injured person out for a “second opinion” exam by an “independent” doctor selected by an insurance claims adjuster or insurance company defense attorney to perform an “independent” medical examination,” also known as an IME.
This is where Michigan’s No-Fault insurance system runs right into the brick wall called reality.
In a state without bad faith laws, punitive damages, or a consumer protection law that allows lawyers to protect Michigan residents from insurance company abuse, the doctors who perform these one-time insurance exams at the behest of insurance companies and workers compensation carriers do some outrageous and dishonest things.
And they routinely get away with it, while making vast amounts of money every year. Sadly, our No-Fault insurance lawyers have to fight these abuses everyday, because every insurance company in Michigan is now using the same “cut-off” doctors to deny and suspend legitimate no fault insurance benefits.
What an “independent” medical exam is really about
While our system of No-Fault benefits (also called personal injury protection (PIP) benefits) sounds great in theory — aside from the newest propaganda war being unleashed against unlimited medical payment by the Insurance Institute of Michigan, whose members are at the same time flush with record-breaking profits — the harsh reality is many accident victims find themselves in a situation where aggressive insurance companies cut off their insurance benefits for no good reason. These insurance companies focus far more on profits than the welfare of their own customers, and these IME examiners that they select play right into this.
Typically, these cut-offs stem from a 10 or 15 minute exam by the IME doctor. These “second opinion” exams are particularly exasperating for car accident victims, many of whom have devastating personal injuries, but soon find their No-Fault benefits halted after the brief examination by a doctor they are told they must see by their insurance claims adjuster. And for No-Fault insurance lawyers in Michigan who see the same notorious doctors performing these insurance examinations time and time again, we know that these independent medical examiners are sadly, anything but independent.
Too many of these doctors are making hundreds of thousands of dollars every year finding nothing wrong with people. Over time, IME doctors have created practices where almost all of their annual income is derived from performing these second-opinion exams (read: cutting off innocent auto accident victims from medical benefits and lost wages). Instead of using their knowledge and expertise to heal and treat, these doctors have devoted their professional lives to helping insurance companies get even richer, especially in Michigan.
You don’t know how bad it is. They crippled one of my clients. I have a suit pending in Suffolk Supreme. I never posted about it on the Pit but what happened is eggregious.
Someday I’ll post the pleading — maybe; typical Zuppa pleading; more investigative journalism then pleading.
The case is on its fourth Judge. Motions to dismiss were made. All papers were fully submitted in March.
Soon as I get another Plaintiff or two I am bringing a big one.
Why is the case on it’s fourth judge?
Three recusals one after another. No decision. If I win things change very, very much for the entire insurance industry and the facts and the law say I should win.
Keep us informed, if you can.