Workers' Compensation carriers are trying out a new strategy to reduce their costs. They don't pay.

In March a patient came to my office and indicated that their injury was job related. I contacted the employer and asked permission to examine and treat; they referred me to their work comp carrier. I called them. They gave permission.

I followed up with the "Doctors First Report of Injury" along with my treatment program and expected timetable and results, etc.
I continue to treat the patient who began to respond even more quickly than anticipated. I submitted regular progress reports and itemized billing. They insurance carrier never challenged my diagnosis, treatment program, nor requested a IME/QME.

I never received payment. I both called and wrote the carrier. No response. Eventually, I filed a "green" lien (so-called in California because the form is green) and submitted this to the Work Comp Appeals Board and to the carrier. No response.

I am now forced to submit a "Declaration of Readiness to Proceed" and go before the court to try to collect my money. California has a 10% penalty/10% annual interest which is a pittance. Since the carrier has not made any attempt to pay or contact me, I assume this tactic is for stalling only. California does have "frivolous delay" rule which entitles me to compensation for lost office hours, attorney's fees, etc. but the courts rarely enforce it. It also gives the court authority to fine the carrier. They don't.

Nonetheless, I am asking for $100 filing fees and $500 for each day/partial day that I am forced to appear before the court.
All this for billing of less than $2500!

Ideally, the work comp system is set up with government oversight to make sure that workers receive necessary care and that physicians are reimbursed for their services. Big business has gained so much power (begun in the early 1980s) that the balance is tipped.

I urge all physicians to pursue strongly any work comp claims that are not promptly reimbursed. Always charge the carrier with frivolous delays when payment is not timely, and they have not challenged your case. Do not compromise and urge the court to recognize that the payment delays are nothing more than a new business tactic that should be severely punished.

Sincerely,.
Lewis Grove, DC

Thank you Dr. Grove!
Until we all fight back, make it cost them and force these companies to think in the only terms they understand-the bottom line-they will continue to try and put you out of business. Their strategy is premised upon nearly everyone giving up and walking away from their bill, and the few who don't they'll pay the penalty. If everyone fights back and penalizes them, their strategy will no longer be profitable. Keep up the good work. Sludgemeister

Hey,
Thanks for the interesting web site.

I am definitely interested in more detailed info on how to combat IME doctors. However, I have not once had one site the Mercy guides to cut off care.

I actually don't think the mercy guides are that restrictive...

I think they should put the mercy guides in a blender with the Vertbral Subluxation Clinical Practice Guidelines and then we would all have something pretty close to perfect that served the entire profession...

I feel I am one of very few of us who have actually read both books cover to cover...

Anyway, enough of that...I think your web site is great...looking forward to more info in the future....
Chiropractically yours...

Todd M. Narson, DC, CCSP

Dear Sirs,
While I find your endeavor admirable and potentially very useful with regards to supplying the profession the needed ammunition with which to fight unfair IMEs and reviews, I do have one issue for you to consider.

You bring forth strong criticism of anyone who would even consider performing an IME. I submit that there are occasions where treatment and billing fraud is a problem within our profession. I believe that the review process is necessary; however, I do agree with your assessment that there is tremendous abuse of this process by reviewers and insurance carriers. Discouraging honest doctors from performing IMEs and peer reviews I feel only leads to greater abuse by the insurance industry. I would actively encourage our colleagues to do IMEs and paper reviews when asked. If our profession does not provide an alternative to the "hatchet men" commonly used by the insurance companies, we really don't have a lot of room to complain when the insurance companies use the same reviewers over and over again.

Something to consider.

Sincerely,

George F. Best, D.C.

Dear Dr. Best,
Thank you for your e-mail. We have always said that we have no problem with intellectually honest IMEs. The problem is, and I hear doctors tell me this constantly, is that insurance companies consistently refuse to re-use those doctors that call it like they see it. I'm amazed at the number of times I have been told by doctors who have done IMEs that were not to the pleasure of the insurance company that hired them that if they did not change them to reflect that care should be discontinued, then they would never be asked again to do an IME by that company. As such, the problem that you prognosticate concerning good doctors not being used is really being created by the insurance companies themselves. The insurance companies hold the check book and therefore decide who they want to hire. If a given reviewer does not tell them something that is consistent with their economic duty to their shareholders, I can assure you that they will choose the doctors of the evening every time, even if there are fair doctors available. As an attorney who sees IMEs every day, nothing frosts an adjuster more than getting an IME back that actually helps the patient. The adjuster always seems to have a comment that they will not use that guy again, or their voice is steeped in dissappointment over the fact that they have to still pay. In short, I think the problem you identify is really a problem of economic natural selection created an maintained by the insurance companies themselves, hence the need for fighting back to establish fairness. As the old saying goes, if you want to make an omellete, you have to break a few eggs. The only people that should be afraid of doing IMEs are those with something to hide or something to gain. If we dissuade them from doing IMEs, then I consider the work of Sludge a success.

Thanks again for your input.

Scott Blair