Second New York Times Article on Workers' Compensation Closer to the Mark
As you can tell from reading my post yesterday, I was not overly impressed by the first installment of the NY Times series on the Workers' Compensation system in New York. I thought it was high on editorial comment, yet lacking in actual analysis of facts that might lead to to productive solutions.
In addition, I still can't understand why they used the tag-line "Meatball Justice". I understand one person described the hearing process as such, but the Times failed to explain why they believe it accurately describes the hearing process. After all, what's wrong with meatballs? My Italian grandma made better meatballs than half the steaks served in New York restaurants! The NY Times obviously meant the tag-line to be derogatory, but that's just the NY Times' liberal elitism showing through. Injured workers don't want "Champagne Justice". They simply want to get to the "meat" of the matter, get the medical treatment they need, and return to work.
But that was yesterday's news. Today , the NY Times regains some credibility by exposing the flawed so called "independent medical examination" within the workers' compensation system - and they do a good job at getting to the heart of the abuses. At the top of the list of abusers are the IME "brokers" who not only set up the exams, but often change the actual doctor reports and sign the doctors' names using signature stamps. The video which shows an actual IME examination and the doctor's explanation for errors in his reports is a must see, maddening classic.
So what's the solution? First - Attorney General Andrew Cuomo must launch an investigation into this fraud. Second - the New York State Office of Professional Misconduct (OPMC) must strip the medical licenses of the the worst IME doctors. Any claimant who gets an exam similar to the one in the Times' video should file a formal complaint with OPMC against that IME doctor. Finally, I would bar insurance companies from contracting with the shady IME brokers . The brokers are making millions doing the dirty work for the insurance companies, giving the insurance companies plausible deniability of this fraud.
Today's article, including the must see video footage online, came much closer to hitting the mark than yesterday. Perhaps the final installment on the New York Workers' Compensation system will hit the bull's eye.
I agree that there needs to be a full investigation into this alleged fraud, but I disagree regarding your comment about the insurance companies using IME vendors to somehow deny fraud. Carriers, TPAs and self-insured employers use IME vendors for the same reason you outsource certain jobs needed for your law firm to function efficiently. Naively, those who administer claims have deferred to these so-called IME experts only to later learn that the entities are not licensed in NY, not adequately trained in NY law, or otherwise under-qualified to perform the services they contract to provide. Several of my clients have been burned by these entities, and it hurts everyone--except the IME vendor.
Contrary to popular belief (and some of the comments by examining physicians in the article), this is not a black-and-white, us-versus-them situation. It is just another example of how the failure to consistently enforce rules, to take the time to carefully investigate potential contractors (including the examining physicians), to learn the rules, to obtain the proper licenses, and to generally take the requisite time to administer claims fairly and effectively.
The 2007 reforms seem to recognize that the "mill mentality" in the WC system has to end. These claims must be given care by everyone who handles them. It's only fair to ALL of the parties.