Trouble is brewing again in the PRND. This time, however, the controversy is tied to the use of Independent Medical Exams, or IME’s, by that states monopolistic carrier, Workforce Safety & Insurance.

On some levels the debate sounds like what we hear elsewhere in the country. Those on the side of the Injured Worker claim that the IME physicians are too often paid mouthpieces for the insurance carrier and their opinions are anything but independent. The carrier argues that the IME is often a necessary component for complex or controversial cases, particularly when symptoms and diagnoses do not match expected parameters for the type of injury involved.

Both sides have valid points. What it truly boils down to is the integrity and quality of the physician selected for the process. Across the country, IME’s are, for the most part, an accepted and integral part of the workers' compensation system.

It is hard to believe that the people of North Dakota could screw this up so badly.

That point really hits home when you realize how little WSI appears to use the IME for the claims they manage. WSI has provided estimates that they only use, on average, 77 independent medical examinations per year. That is out of an average pool of 24,000 new claims per year. This means the agency uses IME’s for less than 1% of all claims.

Still, the argument in North Dakota has elevated to the point where legislators are working to “fix” the problem. Senate Bill 2298 would require administrative hearing officers to review and use the treating doctor's opinion, and not rely on WSI's determination. I've written a bit about WSI, and while I certainly can understand the tendency to not want to rely on any determination they may make, I think that the virtual elimination of the IME will not serve that state well.

But this is a state that is used to doing things that do not serve it well.

One thing I would be remiss in not mentioning was the cost that WSI estimates it incurs for those (on average) 77 IME's it conducts every year. They provided estimates of the total cost “ranging from $231,000 to $308,000”. It took almost all my fingers and toes to cipher that, at the top end, they are spending up to $4,000 per IME.

Yowza. Makes me want to buy my medical degree from the “Artes de la Universidad de Medicina de Timbuktu Norte” (that is the University of Medical Arts of North Timbuktu for those within the PRND) and head to Bismark to do some injured worker reviewin'. I am certain that degree would qualify me for the job.

Of course, it might be tough to find a doctor willing to give an objective opinion in such a “close knit” state. And this is pure conjecture – but a doctor who crosses a state agency that has a history of prosecuting people for buying motivational doo-dads for its employees might be looking at serious jail time. Maybe the IME isn't getting the full $4,000. Maybe the airlines are. That is what happens if you have to fly all your injured out of state for a legitimate IME.  

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