Independent Medical Examinations Can Lead to Bad Faith Insurance Lawsuits

When a person is denied coverage after personal injury, it can come as quite a shock. Insurance is supposed to help in times of need, which is why millions of dollars are paid into insurance companies throughout the year. If an individual is denied coverage under their insurance policy, then that individual can sue for bad faith.

There may be many factors as to why an insurance company would deny coverage to an injured individual. One of those factors could be the result of an independent medical examination (IME). These exams are referred to as ‘independent’ but they are anything but.  Unfortunately, doctors performing the IMEs are hired by the insurance company, providing reports that would ultimately deny claimant coverage.

If you are injured on the job or perhaps a car accident, typically your employer or your insurance company will order an IME to determine the extent of your injury.  IMEs are meant to weed out individuals who are exaggerating their injuries or who are making false claims; however, IMEs can sometimes be used to benefit the insurance companies by providing false reports which ultimately result in a claimant’s benefits or compensation being cut or denied.

A South Dakota man filed a workers compensation lawsuit after receiving an injury on the job. James Mordhorst was injured when a 275-pound sofa fell and struck him on the head and shoulders while he was making a delivery. Mr. Mordhorst was knocked unconscious and initial medical examinations showed a herniated disk in his back. He was then ordered to be examined by an IME doctor who concluded that his injury was no more than a strain, despite there being conflicting results from the previous evaluation.  The insurer who ordered the IME terminated Mr. Mordhorst’s workers’ compensation benefits causing Mr. Mordhorst to eventually sue his insurance company for bad faith.

A New York Times article highlighted the corruption between IME doctors and the insurance companies who hire them. Often times, insurance companies “hand pick” their doctors because of the doctor’s reputation of dismissing injuries, allowing insurance companies to stop coverage, or deny benefits altogether. A video-taped examination of a driver who was injured in an accident found the physician used phrases such as “mild spasm bilaterally,”  and  “the left cervical is tender,” but when it came time to write the report for the compensation board, he did not include his initial findings and cleared the driver for work.  Doctors can be motivated to write these “adjustments” in their reports in an attempt to gain more clients from the insurance company.  IMEs are just one of the many ways insurance companies can find loopholes to terminate a claimant’s coverage so it is important to remember that if you are denied coverage from your insurance company you can request an investigation of the exam.

In most businesses, the goal is to make money and that business model is no different when it comes to insurance companies. Many insurance companies that deny claims or coverage are attempting to increase their profits by hoping that their denial of coverage will not be challenged. At Goldberg, Persky & White, P.C., it is our job to fight for the compensation that you deserve. If you have been denied the coverage that you paid for from your insurance company, you may be able to file a bad faith lawsuit. Our experienced attorneys will make sure the insurance company is punished for its wrongful conduct all while making the insurance company pay the claim, attorney’s fees, and punitive damages.  Contact GPW today to speak with one of our bad faith insurance attorneys.

Sources

N.R. Kleinfield, “Exams of Injured Workers Fuel Mutual Mistrust,” The New York Times (March 31, 2009). [Link]

James “Jake” MORDHORST, Appellant, v. DAKOTA TRUCK UNDERWRITERS AND RISK ADMINISTRATION SERVICES, Appellees, Supreme Court of South Dakota, No. 27771 (September 28, 2016) [Link]

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