Patient Centered Care

Advocates for the patient interest

Patients naturally expect their doctor to be “on their side”. Just as no one would expect one’s own attorney to advance an opponent’s interest in a legal dispute, so one might reasonably expect his/her own doctor would not put the interests of the insurer over those of the patient: The doctor-patient relationship, by definition, makes the medical interests of the patient the number one priority. There is a little known word for this sort of relationship: “Fiduciary”.

Denied by L&I

Frequently, patients with L&I claims find that care plans ordered by their doctors are denied by L&I. Even diagnostic procedures, or claim-related diagnoses may be denied by L&I on the basis of an “Independent Medical Evaluation”, or IME. An IME doctor is one contracted by L&I to review a patient’s care plan, question and examine the patient, and offer suggestions to the claim manager. The IME doctor does NOT have a doctor-patient relationship with you, and is not obligated to prioritize your interest, or even render a medical opinion consistent with any standard of care. The IME doctor has an unacknowledged incentive (i.e. repeat business) to suggest a care plan that is lower cost than the one offered by the attending, and L&I claim managers, themselves under pressure to reduce costs, commonly will defer to the IME opinion, and deny the care plan ordered by YOUR doctor. All too often, many L&I attending doctors do not agitate against adverse IME opinions or even register a protest, in effect resigning themselves to a denial of the care plan that they themselves ordered. Some attendings think IME’s are collegial, not realizing that IME’s are not fiduciary, and so don’t register a protest. I have even seen instances where attendings don’t offer a sound plan of care because they anticipate that it would be denied!

Work Injury Medicine

At Work Injury Medicine, your plan of care will be to the Standard of Care. If you should be on the receiving end of an adverse IME, I will review the underlying medical facts and reasoning. If the facts do not support the adverse opinion, or if the reasoning is invalid, I will vigorously protest. My protests are well-reasoned and worded to enable your labor law attorney to lodge a strong legal appeal against a denial of care.

I won’t give up on you.