Abstract

Patients and their advocates tend to be skeptical about reports produced by independent medical evaluators (IMEs) and file reviewers. There are legitimate reasons for this skepticism, but the author points out two common but erroneous beliefs that create unnecessary distrust in disability benefits and workers’ compensation claim management systems. First, despite patients’ faith in their own doctors, treating physicians as a group are not a reliable source of accurate and unbiased information. Second, although justice attempts to be even-handed, impartial physicians should not find for both sides equally (ie, should not attempt to achieve parity in outcomes), particularly because any case sent for review has some feature that raised questions in the mind of an experienced observer. This experienced observer requires an impartial, expert physician advisor who can confirm that the treating physician is doing the right thing or validate the claims manager's concerns. When claims or case managers are doing a good job of selecting cases for referral, one should expect that most of their decisions will favor the insurer/defense. The more expert the claims/case managers are, the more likely the independent physicians will agree because the claims/case managers are accurately detecting real problems and concerns. In counseling their patients, physicians should not discredit the work of independent experts; doing so increases distrust, resentment, and anger and encourages passivity rather than problem-solving.

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