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Independent Medical Examiners
Criticize Attending Physicians

This is a quote from an article written by a so-called 'Independent' Medical Examiner:

". . . However the most common communication between attending/treating physician and Independent Medical Examiner is not direct (sic) one but rather an indirect one via the medical record generated by the attending physician, which can be valuable in assessing an individual’s claim of impairment or disability. It would be an Independent Medical Examiner’s dream come true if the information in the attending physician’s record were completely accurate, consistent and reliable. Unfortunately, this is often not the case.

No one will argue that in North America we are fortunate to have the finest medical care provided by most systematically trained and dedicated health care providers the world has ever known. Unfortunately for the society at large, there is a tremendous pressure placed on these fine folks to exaggerate services performed to insure that the patients receive benefits and to some degree optimize reimbursement for the provider.

We are all aware of anecdotal evidence that suggests that the more diagnoses that are listed, the more likely the chance of payment being made and some providers may have taken this to creative heights. Obviously, where the payor is a liability company such as automobile insurance carrier or workers’ compensation carrier, there is temptation to maximize disability. This has led some to conclude that there is an environment, which does nothing to correct the pressure to exaggerate medical illness and a system where much money is available for those who are intentionally exaggerating the need for medical services or indicating the performance of a service in a workers’ compensation claim which was not work-related, a phenomenon I regard as cost shifting.

In this regard, Independent Medical Examinations tends to offer a more neutral type of opinion; however, this system is also not without its abusers. We all know of some physicians who do nothing but plaintiff work and others that exclusively perform examination for defense. This ends up in some cases a shouting match between two equally qualified physicians described by some as dueling doctors phenomenon.

So then, what are we supposed to do? I believe that the quality and integrity of the medical records coupled with the intellectually honest and objective analysis of all the information made available to the independent medical examiner is the appropriate course of action. It is imperative to evaluate the source of attending physician’s information and weigh the veracity of these records by many factors. These should include sifting through data from variety of sources and appropriate second opinion consultation from colleagues with appropriate specialty. Hopefully the American Board of Independent Medical Examiners and the Journal Disability Medicine will continue to contribute to this interdisciplinary approach."

Mohammed I. Ranavaya, M.D., M.S., FRCPI, FFOM, FAADEP, CIME
Editor in Chief
Disability Medicine is an educational publication of the American Board of Independent Medical Examiners (ABIME)

Full article at:

Most injured workers who have contacted the CIWS have stated that the attending physician or specialist's diagnosis of their injury is more accurate than the analysis done by the doctor who is being paid by the workers compensation board (the 'IME' or WCB-paid doctor). Therefore, most injured workers would disagree with the above criticism of the attending physician.