Chiropractors Can Now Prevent Adjusters & IME’s From Disputing & Denying Their Claim Factors
INNOVATION
The insurance companies have IME's on their side. Now you can have IMV on your side to override adjuster and IME opinions.
Frank Liberti
DC
If you’re a chiropractor treating personal injury cases, you’re no stranger to the insurance adjusters and their independent medical examiners (IME’s) who dispute and deny your claim factors and cut your fees. Now there is a process being used by Chiropractors to override their opinion’s and win the “Greater Weight” of the evidence challenges.
IME Is Biased Against The Chiropractor
“Independent Medical Evaluation” (IME )is based on opinion, not evidentiary burdens of proof. IME does not conform to regulatory requirements or follow case law to show which side has greater believability and does not establish the preponderance or greater weight evidence.
Excerpts from www.badfaithinsurance.org/ reference/HL/0090a. pdf
Courts, Authorities, Administrative & Judicial Hearings And Rulings Have Declared:
“Independent Medical Validation” (IMV) is used to confirm the accuracy and conformity to facts and evidence-based data to establish the preponderance, show that one side has greater believability and win the greater weight of the evidence challenges.
By Authority Notice:
The process of Independent Medical Validation contains Medical Determinations with “Memorandum Of Points”, “Statements of Undisputed Facts”, “Declarations”, “Exhibits'’’ and “Authorities” to present evidentiary burdens of proof in admissible format to establish preponderance, eliminate varying medical opinions and win the Great Weight of the evidence challenges.
One of its purposes is to produce enough evidencebased data by one side to create a belief that its version is more likely true than not. If such evidence-based data comes under dispute, such dispute must show that the finding is so against the great weight and preponderance of the evidence as to be clearly wrong and manifestly unjust and against authorities.
Winning The Greater Weight Of The Evidence Challenges
In reviewing a “Greater Weight” challenge among disputes and varying medical opinions, one may examine the medical record by process of (IMV) Independent Medical Validation to determine:
1. “If the finding under medical validation is conclusive of the “greater weight,” and the preponderance of the evidence is clearly medically validated and just”.
2. “If the greater weight and preponderance of the evidence are shown to be medically validated and support its existence”.
Cain v. Bain,709 S.W.2d 175 (Tex. 1986):
Proving Symptom Validity
“Symptom Validity Testing” has satisfied the court's evidentiary burdens of proof to determine whose side has greater believability and degree of reasonable medical certainty of clinical judgments on the authenticity of reported symptoms.
C Keppler Et Al. Fortschr Neurol Psychiatr 85 (1), 17-33. 2017 Jan 23
Insurers Rubber Stamp Disputes and Denials
In theory, IME’s are intended to “clarify” very complex medical restrictions and limitations. However, in actual practice, the independent medical evaluation is a “risk management” tool paid for by the defense insurer which “rubber stamps” a future decision to deny the claim. The claim for benefits is “risk-managed,” a term some refer to as “stacking the deck.”
Most defense insurance providers maintain a master list of “IME Physician Network” participants. These IME physicians perform hundreds of medical evaluations each year for the insurance industry and make doing so a large part of their practice. Their bias in favor of the insurance company is well known. The “business” of performing several hundreds of insurance IME’s proves to be very lucrative for the IME physician. For some specialties, performing IME examinations can be more profitable than clinical services!
Medical Examiners Cannot Be Truly Independent Of the Insurance Company Paying Them
When an insurance company hires an "Independent Medical Examiner", the waters immediately become muddied. The reality is that with the insurance company as their de facto employer, these insurance industry physicians are not “independent” in any sense of the word, and can actually add to the controversy involved in determining medical impairment. These "independent" medical examiners often show their true allegiance by drawing conclusions, writing reports, and providing testimony that is clearly biased in favor of the insurance company. Instead of offering an objective opinion, the IME physician ends up playing “devil’s advocate”, rendering opinions and conclusions outside of his or her medical expertise. These "independent" physicians often find their opinions more suited to those of defense claims investigators, paid by the insurance company, to provide documentation adverse to the injured’s claim.
Therefore, it is important to remember IME physicians are not concerned with the insured’s medical well-being and themselves have a clearly defined agenda and strategy to assist the insurance company with what appears to be, a credible, objective medical opinion contrary to that of the primary care physician.
Chiropractors Can Now Refer For the Process Of IMV To Override IME Claim Disputes
The Chiropractor cannot validate his own findings. To establish that your findings carry the greater weight, you can e-mail a copy of the S.O.A.P. notes to an independent, disinterested, 3rd medical party trained in the process of IMV. You’ll receive a lengthy report with a red stamp from the IMV to prevent IME disputes before they occur or help override denials after they occur.
Reimbursable CPT Code
The CPT code for IMV is a reimbursable code and most insurance companies will pay for the process of IMV which overrides their own IME’s.
Visit: www.independentmedicalvalidation.com
£Dr. Frank Liberti has a career spanning 40 years. His advice on personal injury has been published extensively and his work has appeared in NBC, CNN and Entrepreneur Magazine. He has authored 5 books on Colossus and personal injury mandates of litigation, consulted over 35,000 doctors and lawyers on personal injury, is a keynote speaker across the United States and the only chiropractor asked to address the Judicial College. As an expert witness, he helped set precedent at the New Jersey State Supreme Court on personal injury. He offers his knowledge, experience and influence through his P.l. seminar series. For syllabus, dates & locations visit: www.accidentworks.com.
