Lawyer: Doctors not independent in workers comp

Posted at 6:58 PM, Apr 19, 2016
and last updated 2016-04-20 14:31:18-04

The response to our story on workers compensation insurance has been overwhelming.

Many injured workers are reaching out saying they feel they are not getting the care they deserve.  They say the system empowers insurance companies to fight people with legitimate claims in their time of need.

Tonight - one attorney says he has proof insurance companies are working with dishonest doctors to cut patients off of benefits.

“This is the one that was for the insurance company, this is the one for judge and us,” said Joel Alpert, as he showed 7 Action News two diagnostic reports.

Information was edited out of the report given to the judge and patients attorney.

“It is proof these doctors are not independent. They are working with the insurance company to defeat the patient’s claim,” said Alpert.

Doctors hired by workman’s compensation insurance companies are often called independent medical examiners. Attorneys who represent patients say many of them make between $500,000 and $700,000 a year. 

Alpert reached out to 7 Action News after seeing the story of Mark Marusza.  His family physician diagnosed him with a traumatic brain injury after an SUV hit him while he was on the clock.

He said it is so severe he needs attendant care. His memory is dangerously unreliable. Then the insurance company forced Mark to go to three specialists.

When two out of three said he had no brain injury, the insurance company ignored the one doctor it hired who said he was in need, and cut off his benefits. He has been fighting the decision in court.

“This is just the tip of the iceberg,” said Marshall Lasser, the attorney representing Mark. “This is one of thousands of cases like it every year in Michigan.”

For the record the insurance company in that case released a statement that it is following the law.

An attorney who is often on the other side of these cases also reached out to 7 Action News after hearing about our story. Albert Nelson, Jr. has spent decades representing companies in workers compensation cases. He says the system works, because patients can take their case to court.

He says a doctor shouldn’t give one diagnostic report to the insurance company and another to the court, but the good thing is a magistrate overseeing the case takes integrity into account. He says there are consequences for abhorrent behavior. 

“That party doesn’t win,” said Nelson.

Marshall has filed a lawsuit in federal court that accuses the insurance companies and doctors of racketeering against patients. 

He says the court does not provide accountability because there are very limited discovery rules in workers compensation cases.

“The magistrates will not permit a lawyer to discover and introduce into evidence how much money doctors make from doing ‘independent medical exams’ in one year, let alone year after year. And cannot obtain reports the IME doctor has written in scores or hundreds of other cases to prove a pattern of fraud. A magistrate looks only at the report in the case at hand,” said Lasser.