A Medical Cost You Didn’t Know About

Most of us have never heard of independent medical examinations. We might need to know a little more about them. 

An independent medical examination (IME) is an exam performed when there is litigation related to a sick or injured person’s medical condition that requires more than the opinion of the treating physician. A doctor is hired – or, if necessary, a few doctors with different specialties – to give an unbiased opinion. 

New Mexico workers’ compensation has an unusual system for IMEs. If the parties can’t agree to an IME physician and the judge has to select one, the judge may only pick from a list of doctors approved annually by a committee. The committee members are selected by the Workers’ Compensation Advisory Council. Ironically, selecting these committee members is the only actual power the Advisory Council has; everything else it does is advisory only. The IME Committee, however, has real power, for just this one thing.

The Advisory Council has been mostly following the Open Meetings Act, in part because I helped set it up years ago when I worked there. But until now, the IME Committee has been closed. That is about to change.

Here’s the origin of this odd process. Prior to the 1990 workers’ compensation reform, any doctor could do IMEs, but some doctors were regarded as biased and were deeply distrusted by either the insurance community or plaintiff attorneys. The committee was established as part of the reform, to screen out the biased doctors. Physicians who wanted to be eligible for IMEs ordered by a judge had to apply to the committee. 

After a few years most doctors stopped applying, and for a while there were not enough to meet the demand. I think there has been considerable increase in IME activity, and that would be useful information for public policy, but it’s not being tracked in any publicly available statistics.

New Mexico workers’ compensation has a medical fee schedule, which is supposed to limit what doctors charge, but IME charges are not regulated. 

The list of IME approved providers is public, accessible on the website of the Workers’ Compensation Administration. But the committee meetings have always been secret. After wondering why for several years, I realized there was no good reason, so I asked the Workers’ Compensation Administration about it and asked the Foundation for Open Government for a little help. We now have assurance that the meetings will be open.

You might be asking why this is of any importance. Here’s why.

First, the IME committee does the public’s business. Indirectly, it has the power to shape the outcomes of lawsuits that affect seriously injured workers. And it affects an insurance system that we all pay for. So it should be transparent. 

Second, medical malpractice and personal injury litigation also use IMEs. Those systems are far less regulated than workers’ compensation and we are all paying for them, partly through government and partly through our own insurance. 

Finally, medical-related litigation will be a factor when New Mexico eventually passes a paid family and medical leave law. There is no getting around that. Issues will arise that lead to litigation and add costs. 

Right now among policy makers there is a quiet but furious dispute going on about the next round of legislation on paid family and medical leave. Some issues in that system will be comparable to issues in workers’ compensation. New Mexico did an imperfect but thorough job addressing those issues in our reform 33 years ago, and it should serve as a model. The bill drafters for this new system should study it.

 Contact Merilee Dannemann through www.triplespacedagain.com.