Ethical considerations for the IME, continued  

The utilization of independent medical examiners (frequently chiropractors, when chiropractic claims are in question) to render opinions favoring the insurer is another common ploy when the carrier would rather keep the money than pay claims. An independent D.C. is hired by an insurer to review paperwork and even examine patients, in order to make a determination regarding the necessity of future chiropractic services, and the possibility that previously rendered care was done spuriously. This IME will write reports, and appear in court if necessary, to allege that the D.C. in question provided unnecessary care unworthy of reimbursement. Obviously there are some differences of opinion concerning " doing the right thing."

When a conflict occurs about right action in a particular situation the various schools of thought in the field of ethics offer several approaches for arriving at a right decision.

  • The Utilitarian Approach emphasizes the consequences of actions on the well-being of all parties affected by the actions.

  • The Rights Approach declares that a correct action will always respect the fundamental rights of an individual, e.g. privacy, self direction and expectation of fairness.

  • The Justice Approach asks "how fair is an action? Does it treat everyone equally or is it discriminatory?"

  • The Common-Good Approach assumes that right and ethical actions will benefit individuals as well as society and community.

An ethical chiropractor would need to examine his or her own motives for engaging in the sideline of Independent Medical Examining. Some serious questioning is needed to determine if he/ she is, in fact, participating in an activity that will make the world a better place.

Some considerations for the aspiring IME:

  • Why am I even considering becoming an IME? Do I just need the consulting fee? Does it make me feel really smart to have my opinion considered "expert" opinion? Will my fellow chiropractors think more of me, or fear my power and authority? Will my delusions of adequacy be fed? Am I serving my profession, the insurer or myself?

  • What are the consequences of my actions? To the patient? The D.C. providing care to the patient? The insurer? Will the patient's best interests be met by eliminating the possibility of chiropractic care? Will the D.C. not be paid for services given in good faith? Will the insurance company suffer if they have to pay this claim?

  • If I work for the insurer, can I be truly "independent"? If my opinion goes in favor of the patient, will I ever work again as an IME? Does the insurer put pressure on me to find in their favor?

  • Does a patient really have the right to choose a health care system that is not the dominant system? How do I feel about a patient's right to do the unpopular thing? What if the unpopular choice involves chiropractic care?

  • Is it fair to discriminate against minority methods in health care? Do insurers really consider the best interests of insured parties when it comes to paying claims for less popular methods of care? Do I want to help promote this discrimination?

  • Do I serve my profession well? Is it a profession worth serving? Does chiropractic deserve a better positioning in the larger health care field? Do my actions raise it to its rightful status, or demean its philosophy and practitioners?

  • Do insurers uphold high ethical standards? Do I want to associate myself with organizations which put profit above fair dealing? Does the insurance industry need my help? Why would I be willing to help?

I would hope that chiropractors considering the sideline business of being an IME would ask these questions, and many others, of themselves before entering into alliances with the insurance industry. Perhaps the D.C. with time on his/ her hands could provide care for a few more patients, teach a few more classes, give a few more public service lectures, and participate a little more in state and national organizations. Perhaps our involvement with insurance companies would  be better spent speaking to state and local insurance officials about how wellness chiropractic care can improve quality of life for them and their families as well as insured people and their families.

Leslie M. Wise, D.C.
Director of Clinical Sciences
Sherman College of Straight Chiropractic
Spartanburg, SC  

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