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."
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.
Utilitarian Approach emphasizes
the consequences of actions on the well-being of all parties
affected by the actions.
Rights Approach declares
that a correct action will always respect the fundamental rights of
an individual, e.g. privacy, self direction and expectation of
asks "how fair is an action? Does it treat everyone equally or
is it discriminatory?"
Common-Good Approach assumes
that right and ethical actions will benefit individuals as well as
society and community.
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.
considerations for the aspiring IME:
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?
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?
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
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?
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.
M. Wise, D.C.
Director of Clinical Sciences
Sherman College of Straight Chiropractic
this article in the forum